Provider Demographics
NPI:1861675712
Name:MILLER, REBECCA PAULINE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:PAULINE
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 1:1 FALCON CRST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-1134
Mailing Address - Country:US
Mailing Address - Phone:518-762-4855
Mailing Address - Fax:
Practice Address - Street 1:172 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-2401
Practice Address - Country:US
Practice Address - Phone:518-773-7591
Practice Address - Fax:518-773-3878
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1336248699Medicaid