Provider Demographics
NPI:1689965709
Name:MILLER, LYNN CARROLL (RPH)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:CARROLL
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 521
Mailing Address - Street 2:
Mailing Address - City:BERKELEY SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:25411-0521
Mailing Address - Country:US
Mailing Address - Phone:304-258-4955
Mailing Address - Fax:304-258-8153
Practice Address - Street 1:8 GAYLE DR
Practice Address - Street 2:
Practice Address - City:BERKELEY SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:25411-6300
Practice Address - Country:US
Practice Address - Phone:304-258-4955
Practice Address - Fax:304-258-8153
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-23
Last Update Date:2011-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0002805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist