Provider Demographics
NPI:1013469055
Name:MILLER, CHERYL (RPH)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
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 1:100 E WALLACE KNEELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-2981
Mailing Address - Country:US
Mailing Address - Phone:360-427-0171
Mailing Address - Fax:360-427-0404
Practice Address - Street 1:100 E WALLACE KNEELAND BLVD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-2981
Practice Address - Country:US
Practice Address - Phone:360-427-0171
Practice Address - Fax:360-427-0404
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00011512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist