Provider Demographics
NPI:1134630601
Name:MILLER, PANTEA MATIAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PANTEA
Middle Name:MATIAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23805 MALIBU RD
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4644
Mailing Address - Country:US
Mailing Address - Phone:310-456-9645
Mailing Address - Fax:
Practice Address - Street 1:23805 MALIBU RD
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4644
Practice Address - Country:US
Practice Address - Phone:310-456-9645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73623183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist