Provider Demographics
NPI:1801836473
Name:MILLERS FAMILY PHARMACY & GIFT BOUTIQUE INC
Entity Type:Organization
Organization Name:MILLERS FAMILY PHARMACY & GIFT BOUTIQUE INC
Other - Org Name:MILLERS FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:337-779-2214
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:IOTA
Mailing Address - State:LA
Mailing Address - Zip Code:70543-0429
Mailing Address - Country:US
Mailing Address - Phone:337-779-2214
Mailing Address - Fax:337-779-2215
Practice Address - Street 1:119 S 5TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:IOTA
Practice Address - State:LA
Practice Address - Zip Code:70543-6105
Practice Address - Country:US
Practice Address - Phone:337-779-2214
Practice Address - Fax:337-779-2215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BN1400X, 333600000X, 3336C0004X, 3336L0003X
LAPHY003535IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1264105Medicaid
2028743OtherPK
2028743OtherPK