Provider Demographics
NPI:1902182454
Name:MILLER, RICHARD DEAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DEAN
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 JACOLYN PL NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3316
Mailing Address - Country:US
Mailing Address - Phone:770-235-5617
Mailing Address - Fax:
Practice Address - Street 1:2700 NORTHEAST EXPY NE STE B800
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-1828
Practice Address - Country:US
Practice Address - Phone:855-443-9944
Practice Address - Fax:855-322-2087
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026178183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH026178OtherPHARMACIST LICENSE