Provider Demographics
NPI:1851673081
Name:MILLER, RONALD CRAIG (BS)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:CRAIG
Last Name:MILLER
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1857 FOXFIELD DR APT 2
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-5338
Mailing Address - Country:US
Mailing Address - Phone:630-236-4595
Mailing Address - Fax:
Practice Address - Street 1:1857 FOXFIELD DR.
Practice Address - Street 2:APT 2
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504
Practice Address - Country:US
Practice Address - Phone:630-236-4595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-037229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist