Provider Demographics
NPI:1184090326
Name:MILLER, MARC (PHARMD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22125 N 29TH AVE
Mailing Address - Street 2:#141
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-1778
Mailing Address - Country:US
Mailing Address - Phone:602-550-1857
Mailing Address - Fax:
Practice Address - Street 1:4965 W BELL RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3418
Practice Address - Country:US
Practice Address - Phone:602-843-2305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZI010581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist