Provider Demographics
NPI:1700965852
Name:MILLER, DIANE MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
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 1:118 CENTER STREET
Mailing Address - Street 2:PO BOX 130
Mailing Address - City:CONRAD
Mailing Address - State:IA
Mailing Address - Zip Code:50621
Mailing Address - Country:US
Mailing Address - Phone:641-366-2774
Mailing Address - Fax:888-557-3598
Practice Address - Street 1:118 CENTER STREET
Practice Address - Street 2:
Practice Address - City:CONRAD
Practice Address - State:IA
Practice Address - Zip Code:50621
Practice Address - Country:US
Practice Address - Phone:641-366-2774
Practice Address - Fax:888-557-3598
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17466183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist