Provider Demographics
NPI:1295273241
Name:MILLER, TRISHA A (RPH; PHARMD)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:RPH; PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2239 S COTTONWOOD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6389
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16240 N FORT MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:FORT MCDOWELL
Practice Address - State:AZ
Practice Address - Zip Code:85264-3402
Practice Address - Country:US
Practice Address - Phone:480-789-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS013998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist