Provider Demographics
NPI:1043708688
Name:MILLER, LAURA JO (RPH)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JO
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 1:6414 N STATE ROUTE 139
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-8635
Mailing Address - Country:US
Mailing Address - Phone:740-456-5167
Mailing Address - Fax:
Practice Address - Street 1:9101 OHIO RIVER RD
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-1927
Practice Address - Country:US
Practice Address - Phone:740-574-6569
Practice Address - Fax:740-574-6728
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03322061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist