Provider Demographics
NPI:1659895688
Name:MILLER, CHAD (RPH)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
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:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:MERMENTAU
Mailing Address - State:LA
Mailing Address - Zip Code:70556-0032
Mailing Address - Country:US
Mailing Address - Phone:337-368-1111
Mailing Address - Fax:337-824-3301
Practice Address - Street 1:1204 ELTON RD
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-4136
Practice Address - Country:US
Practice Address - Phone:337-824-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE