Provider Demographics
NPI:1336372564
Name:MILLER, LAURENCE MARK (RPH)
Entity Type:Individual
Prefix:MR
First Name:LAURENCE
Middle Name:MARK
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 1:4 DOUBLEWOODS RD
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1078
Mailing Address - Country:US
Mailing Address - Phone:215-968-4656
Mailing Address - Fax:
Practice Address - Street 1:4 DOUBLEWOODS RD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1078
Practice Address - Country:US
Practice Address - Phone:215-968-4656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP027285L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist