Provider Demographics
NPI:1770868358
Name:MILLER, DEREK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FOREST FALLS DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6936
Mailing Address - Country:US
Mailing Address - Phone:207-846-1375
Mailing Address - Fax:
Practice Address - Street 1:10 FOREST FALLS DR
Practice Address - Street 2:SUITE 4
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6936
Practice Address - Country:US
Practice Address - Phone:207-846-1375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5937183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist