Provider Demographics
NPI:1033079850
Name:MILLER, GRANT THOMAS (RPHT)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:THOMAS
Last Name:MILLER
Suffix:
Gender:M
Credentials:RPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5808 BURNET RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-1100
Mailing Address - Country:US
Mailing Address - Phone:512-454-6691
Mailing Address - Fax:866-585-2752
Practice Address - Street 1:5808 BURNET RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-1100
Practice Address - Country:US
Practice Address - Phone:512-454-6691
Practice Address - Fax:866-585-2752
Is Sole Proprietor?:No
Enumeration Date:2025-11-14
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX257708183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician