Provider Demographics
NPI:1295085082
Name:MILLER, GINGER L (RPH)
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
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:PO BOX 1068
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-1068
Mailing Address - Country:US
Mailing Address - Phone:417-532-9110
Mailing Address - Fax:417-532-9156
Practice Address - Street 1:223 E 7TH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-2706
Practice Address - Country:US
Practice Address - Phone:417-532-9110
Practice Address - Fax:417-532-9156
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO43905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist