Provider Demographics
NPI:1689966335
Name:MILLER, CHERYL ANN
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 SULLIVANS CT
Mailing Address - Street 2:
Mailing Address - City:POWELLS POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27966-9621
Mailing Address - Country:US
Mailing Address - Phone:252-491-2476
Mailing Address - Fax:
Practice Address - Street 1:5547 N CROATAN HWY
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-4090
Practice Address - Country:US
Practice Address - Phone:252-261-8097
Practice Address - Fax:252-261-0654
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist