Provider Demographics
NPI:1629138714
Name:MILLER DRUG CO INC
Entity Type:Organization
Organization Name:MILLER DRUG CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER SECRETARY TREASURE
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORA
Authorized Official - Middle Name:F
Authorized Official - Last Name:JERNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PT
Authorized Official - Phone:205-625-4421
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:AL
Mailing Address - Zip Code:35121
Mailing Address - Country:US
Mailing Address - Phone:205-625-4421
Mailing Address - Fax:205-625-5107
Practice Address - Street 1:212 1ST AVE EAST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121
Practice Address - Country:US
Practice Address - Phone:205-625-4421
Practice Address - Fax:205-625-5107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1067853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL10000223ZMedicaid
0108870Medicare UPIN
0174510001Medicare ID - Type UnspecifiedREGION C