Provider Demographics
NPI:1871868943
Name:MILLER, MALISSA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MALISSA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-2250
Mailing Address - Country:US
Mailing Address - Phone:660-646-7455
Mailing Address - Fax:660-646-4838
Practice Address - Street 1:601 LOCUST ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-2250
Practice Address - Country:US
Practice Address - Phone:660-646-7455
Practice Address - Fax:660-646-4838
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011023694183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist