Provider Demographics
NPI:1356520878
Name:MILLER, PHYLLIS A (RPH)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:A
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 1:306 SW CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LEON
Mailing Address - State:IA
Mailing Address - Zip Code:50144-1351
Mailing Address - Country:US
Mailing Address - Phone:641-446-6674
Mailing Address - Fax:641-446-6217
Practice Address - Street 1:204 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LEON
Practice Address - State:IA
Practice Address - Zip Code:50144-1450
Practice Address - Country:US
Practice Address - Phone:641-446-4127
Practice Address - Fax:641-446-6217
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist