Provider Demographics
NPI:1659441079
Name:MILLER, MISTI K (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MISTI
Middle Name:K
Last Name:MILLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13154 ROAD 176
Mailing Address - Street 2:
Mailing Address - City:PAULDING
Mailing Address - State:OH
Mailing Address - Zip Code:45879-8829
Mailing Address - Country:US
Mailing Address - Phone:419-769-4002
Mailing Address - Fax:
Practice Address - Street 1:1804 N CLINTON ST
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-8556
Practice Address - Country:US
Practice Address - Phone:419-784-2390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03118992183500000X
OH03-1-18992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist