Provider Demographics
NPI:1255609988
Name:MILLER, JIMMIE
Entity type:Individual
Prefix:
First Name:JIMMIE
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 BUFFALO CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:DUNCANNON
Mailing Address - State:PA
Mailing Address - Zip Code:17020-7052
Mailing Address - Country:US
Mailing Address - Phone:717-343-7508
Mailing Address - Fax:
Practice Address - Street 1:123 BUFFALO CREEK RD
Practice Address - Street 2:
Practice Address - City:DUNCANNON
Practice Address - State:PA
Practice Address - Zip Code:17020-7052
Practice Address - Country:US
Practice Address - Phone:717-343-7508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician