Provider Demographics
NPI:1811543218
Name:MILLER, DONALD EUGENE II
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:EUGENE
Last Name:MILLER
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 MORNING GLORY PL
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-1560
Mailing Address - Country:US
Mailing Address - Phone:570-490-4672
Mailing Address - Fax:
Practice Address - Street 1:1 GREAT VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18706-5324
Practice Address - Country:US
Practice Address - Phone:570-820-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP437706183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist