Provider Demographics
NPI:1750445011
Name:MILLER, MELVIN ROBERT (RPH)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:ROBERT
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 1:1703 N LOOP 1604 WEST
Mailing Address - Street 2:APT. 4104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258
Mailing Address - Country:US
Mailing Address - Phone:210-887-8507
Mailing Address - Fax:
Practice Address - Street 1:12500 SAN PEDRO AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2858
Practice Address - Country:US
Practice Address - Phone:877-277-5900
Practice Address - Fax:210-499-0672
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25909183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist