Provider Demographics
NPI:1639633548
Name:MILLERS MEDICAL ARTS INC
Entity Type:Organization
Organization Name:MILLERS MEDICAL ARTS INC
Other - Org Name:MILLERS MEDICAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:660-885-5208
Mailing Address - Street 1:800 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233-1658
Mailing Address - Country:US
Mailing Address - Phone:660-882-5208
Mailing Address - Fax:660-882-8125
Practice Address - Street 1:800 MAIN ST
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233-1658
Practice Address - Country:US
Practice Address - Phone:660-882-5208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILLERS MEDICAL ARTS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2604519OtherNCPDP