Provider Demographics
NPI:1639696560
Name:MILLER, NICHOLAS JOSHUA
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JOSHUA
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16528 E DESMET CT STE C1301
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-3522
Mailing Address - Country:US
Mailing Address - Phone:509-926-6400
Mailing Address - Fax:509-926-6574
Practice Address - Street 1:16528 E DESMET CT STE C1301
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-3522
Practice Address - Country:US
Practice Address - Phone:509-926-6400
Practice Address - Fax:509-926-6574
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60757039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist