Provider Demographics
NPI:1780680629
Name:MILLER, ANGELA ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:BRATTAIN
Other - Last Name:HACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1155 COUNTY ROAD 2011
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-0461
Mailing Address - Country:US
Mailing Address - Phone:317-418-4162
Mailing Address - Fax:317-346-1456
Practice Address - Street 1:200 GASLIGHT BLVD
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3166
Practice Address - Country:US
Practice Address - Phone:936-639-2346
Practice Address - Fax:936-639-2322
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60982183500000X
IN26019205A183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist