Provider Demographics
NPI:1871875443
Name:MILLER, CLAYTON J (PHARM D)
Entity type:Individual
Prefix:MR
First Name:CLAYTON
Middle Name:J
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 W FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-5662
Mailing Address - Country:US
Mailing Address - Phone:507-451-3323
Mailing Address - Fax:
Practice Address - Street 1:1130 W FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-5662
Practice Address - Country:US
Practice Address - Phone:507-451-3323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120217183500000X
CO18867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist