Provider Demographics
NPI:1629131248
Name:MILLERS PHARMACY OF FARMINGTON
Entity Type:Organization
Organization Name:MILLERS PHARMACY OF FARMINGTON
Other - Org Name:MILLERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-924-1676
Mailing Address - Street 1:6181 ROUTE 96
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:14425-1004
Mailing Address - Country:US
Mailing Address - Phone:585-924-1676
Mailing Address - Fax:585-924-8763
Practice Address - Street 1:6181 ROUTE 96
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NY
Practice Address - Zip Code:14425-1004
Practice Address - Country:US
Practice Address - Phone:585-924-1676
Practice Address - Fax:585-924-8763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
NY0244953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020571156Medicaid
3392850OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY020571156Medicaid