Provider Demographics
NPI:1255417366
Name:MILLER, DAVID LEE (RPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2093 ALDERSGATE DR
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-3807
Mailing Address - Country:US
Mailing Address - Phone:440-605-0840
Mailing Address - Fax:
Practice Address - Street 1:2475 E 22ND ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3221
Practice Address - Country:US
Practice Address - Phone:216-621-9073
Practice Address - Fax:216-621-9685
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03211500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist