Provider Demographics
NPI:1669843314
Name:MILLER, MARSHA C (RPH)
Entity Type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:C
Last Name:MILLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:MARSHA
Other - Middle Name:C
Other - Last Name:MILLER-MARABLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:39 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-3913
Mailing Address - Country:US
Mailing Address - Phone:631-667-7735
Mailing Address - Fax:
Practice Address - Street 1:39 W 20TH ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-3913
Practice Address - Country:US
Practice Address - Phone:631-667-7735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist