Provider Demographics
NPI:1255564498
Name:MILLER, JANET MUSTEN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:MUSTEN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 OLD HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:WALKERTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27051-9579
Mailing Address - Country:US
Mailing Address - Phone:336-595-2137
Mailing Address - Fax:336-595-4082
Practice Address - Street 1:3015 OLD HOLLOW RD
Practice Address - Street 2:
Practice Address - City:WALKERTOWN
Practice Address - State:NC
Practice Address - Zip Code:27051-9579
Practice Address - Country:US
Practice Address - Phone:336-595-2137
Practice Address - Fax:336-595-4082
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7966183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0346858Medicaid