Provider Demographics
NPI:1043695323
Name:MILLER, MARY (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 N 25TH ST
Mailing Address - Street 2:PICKNSAVE PHARMACY 6432
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3168
Mailing Address - Country:US
Mailing Address - Phone:920-457-5839
Mailing Address - Fax:920-457-5853
Practice Address - Street 1:1317 N 25TH ST
Practice Address - Street 2:PICKNSAVE PHARMACY 6432
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3168
Practice Address - Country:US
Practice Address - Phone:920-457-5839
Practice Address - Fax:920-457-5853
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10430-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist