Provider Demographics
NPI:1659694461
Name:MILLER, JENNIFER KATHLEEN (RPH)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:KATHLEEN
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 1:518 E GUARDLOCK DR
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-1861
Mailing Address - Country:US
Mailing Address - Phone:570-975-1049
Mailing Address - Fax:
Practice Address - Street 1:167 HOGAN BLVD
Practice Address - Street 2:WALMART #2528
Practice Address - City:MILL HALL
Practice Address - State:PA
Practice Address - Zip Code:17751-1902
Practice Address - Country:US
Practice Address - Phone:570-893-8184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040930L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist