Provider Demographics
NPI:1942586664
Name:MILLER, STEPHEN WILLIAM JR
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WILLIAM
Last Name:MILLER
Suffix:JR
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 1:9616 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-2104
Mailing Address - Country:US
Mailing Address - Phone:410-663-7957
Mailing Address - Fax:
Practice Address - Street 1:9616 HARFORD RD
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-2104
Practice Address - Country:US
Practice Address - Phone:410-663-7957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist