Provider Demographics
NPI:1629666359
Name:MILLER, MELODY
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 MCKEE RD
Mailing Address - Street 2:
Mailing Address - City:COGAN STATION
Mailing Address - State:PA
Mailing Address - Zip Code:17728-8404
Mailing Address - Country:US
Mailing Address - Phone:570-506-3014
Mailing Address - Fax:
Practice Address - Street 1:1916 LYCOMING CREEK RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1205
Practice Address - Country:US
Practice Address - Phone:570-326-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty