Provider Demographics
NPI:1083453732
Name:MILLER PRINCIPLE MANAGEMENT, LLC
Entity type:Organization
Organization Name:MILLER PRINCIPLE MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:OLIN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:870-253-9646
Mailing Address - Street 1:6315 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-8841
Mailing Address - Country:US
Mailing Address - Phone:870-253-9646
Mailing Address - Fax:
Practice Address - Street 1:47 HIGHWAY 71 BYPASS SOUTH
Practice Address - Street 2:
Practice Address - City:WALDRON
Practice Address - State:AR
Practice Address - Zip Code:72958
Practice Address - Country:US
Practice Address - Phone:479-637-0222
Practice Address - Fax:479-637-0330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILLER PRINCIPLE MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-22
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy