Provider Demographics
NPI:1861670036
Name:MILLER, KENNETH C (RPH)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:C
Last Name:MILLER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 WALLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-3441
Mailing Address - Country:US
Mailing Address - Phone:908-281-7495
Mailing Address - Fax:
Practice Address - Street 1:550 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1914
Practice Address - Country:US
Practice Address - Phone:973-394-9580
Practice Address - Fax:973-394-9588
Is Sole Proprietor?:No
Enumeration Date:2008-02-09
Last Update Date:2008-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist