Provider Demographics
NPI:1336743681
Name:MILLER, JAMES DAVID (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
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 1:14366 DRAKE CT
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-6281
Mailing Address - Country:US
Mailing Address - Phone:574-271-9636
Mailing Address - Fax:
Practice Address - Street 1:130 E CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-5620
Practice Address - Country:US
Practice Address - Phone:574-247-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26015768A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist