Provider Demographics
NPI:1831938901
Name:MILLER, ALEXANDRA SUMNER FALLIN (RPH)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:SUMNER FALLIN
Last Name:MILLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:SUMNER
Other - Last Name:FALLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5625 S NC 41 HWY
Mailing Address - Street 2:
Mailing Address - City:WALLACE
Mailing Address - State:NC
Mailing Address - Zip Code:28466-6095
Mailing Address - Country:US
Mailing Address - Phone:910-285-3411
Mailing Address - Fax:
Practice Address - Street 1:5625 S NC 41 HWY
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466-6095
Practice Address - Country:US
Practice Address - Phone:910-285-3411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist