Provider Demographics
NPI:1871779645
Name:MILLER, RANDOLPH MELVIN (RPH)
Entity type:Individual
Prefix:MR
First Name:RANDOLPH
Middle Name:MELVIN
Last Name:MILLER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:HOLMEN
Mailing Address - State:WI
Mailing Address - Zip Code:54636-8927
Mailing Address - Country:US
Mailing Address - Phone:608-526-1526
Mailing Address - Fax:608-526-1554
Practice Address - Street 1:1303 MAIN ST S
Practice Address - Street 2:
Practice Address - City:HOLMEN
Practice Address - State:WI
Practice Address - Zip Code:54636-8927
Practice Address - Country:US
Practice Address - Phone:608-526-1526
Practice Address - Fax:608-526-1554
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8838-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist