Provider Demographics
NPI:1780110361
Name:MILLER, MICAH (PHARMD)
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S 48TH AVE APT H7
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3657
Mailing Address - Country:US
Mailing Address - Phone:406-670-0587
Mailing Address - Fax:
Practice Address - Street 1:2519 MAIN ST
Practice Address - Street 2:
Practice Address - City:UNION GAP
Practice Address - State:WA
Practice Address - Zip Code:98903-1605
Practice Address - Country:US
Practice Address - Phone:509-453-3603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT34565183500000X
WA60723025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist