Provider Demographics
NPI:1871862771
Name:MILLER, MARK ALAN (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
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 1:6680 THOMASVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-3836
Mailing Address - Country:US
Mailing Address - Phone:850-907-1763
Mailing Address - Fax:850-907-1766
Practice Address - Street 1:6680 THOMASVILLE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-3836
Practice Address - Country:US
Practice Address - Phone:850-907-1763
Practice Address - Fax:850-907-1766
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS21797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist