Provider Demographics
NPI:1013626209
Name:MILLER, BLAIR
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9701 MARGO ST
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-4394
Mailing Address - Country:US
Mailing Address - Phone:402-446-2091
Mailing Address - Fax:
Practice Address - Street 1:16418 WESTSIDE DR
Practice Address - Street 2:
Practice Address - City:PLATTSMOUTH
Practice Address - State:NE
Practice Address - Zip Code:68048-6102
Practice Address - Country:US
Practice Address - Phone:402-296-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17587183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist