Provider Demographics
NPI:1790959401
Name:MILLER, DIANNE ELIZABETH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:ELIZABETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-5166
Mailing Address - Country:US
Mailing Address - Phone:517-484-1466
Mailing Address - Fax:517-484-4893
Practice Address - Street 1:815 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-5166
Practice Address - Country:US
Practice Address - Phone:517-484-1466
Practice Address - Fax:517-484-4893
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410883183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist