Provider Demographics
NPI:1013992270
Name:MILLER DRUG CO INC.
Entity Type:Organization
Organization Name:MILLER DRUG CO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:PERSIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-938-1103
Mailing Address - Street 1:540 S LAKE ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46403-2473
Mailing Address - Country:US
Mailing Address - Phone:219-938-1103
Mailing Address - Fax:219-938-3252
Practice Address - Street 1:540 S LAKE ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46403-2473
Practice Address - Country:US
Practice Address - Phone:219-938-1103
Practice Address - Fax:219-938-3252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60002068A333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy