Provider Demographics
NPI:1760840656
Name:MILLER, SHANON (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHANON
Middle Name:
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 1:601 3RD PL
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-5908
Mailing Address - Country:US
Mailing Address - Phone:785-587-8648
Mailing Address - Fax:785-587-8679
Practice Address - Street 1:601 3RD PL
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-5908
Practice Address - Country:US
Practice Address - Phone:785-587-8648
Practice Address - Fax:785-587-8679
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-16927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist