Provider Demographics
NPI:1063808715
Name:MILLER, BRIAN (RPH)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
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 1:605 VICCARS LN
Mailing Address - Street 2:
Mailing Address - City:MANTEO
Mailing Address - State:NC
Mailing Address - Zip Code:27954-8011
Mailing Address - Country:US
Mailing Address - Phone:651-829-0860
Mailing Address - Fax:
Practice Address - Street 1:1901 N CROATAN HWY
Practice Address - Street 2:
Practice Address - City:KILL DEVIL HILLS
Practice Address - State:NC
Practice Address - Zip Code:27948-8978
Practice Address - Country:US
Practice Address - Phone:252-441-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist