Provider Demographics
NPI:1851761373
Name:MILLER, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 N CROATAN HWY
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-3877
Mailing Address - Country:US
Mailing Address - Phone:252-261-3310
Mailing Address - Fax:252-261-0746
Practice Address - Street 1:5400 N CROATAN HWY
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-3877
Practice Address - Country:US
Practice Address - Phone:252-261-3310
Practice Address - Fax:252-261-0746
Is Sole Proprietor?:No
Enumeration Date:2015-09-26
Last Update Date:2015-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15046183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist