Provider Demographics
NPI:1679085088
Name:MILLER, AMANDA MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 COUNTY ROAD 144
Mailing Address - Street 2:
Mailing Address - City:ANTWERP
Mailing Address - State:OH
Mailing Address - Zip Code:45813-9700
Mailing Address - Country:US
Mailing Address - Phone:419-371-4711
Mailing Address - Fax:
Practice Address - Street 1:109 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:ANTWERP
Practice Address - State:OH
Practice Address - Zip Code:45813
Practice Address - Country:US
Practice Address - Phone:419-258-2068
Practice Address - Fax:419-371-4711
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03230389183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist