Provider Demographics
NPI:1104913441
Name:MILLER, GAYLE MARIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2870 W ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9522
Mailing Address - Country:US
Mailing Address - Phone:734-996-5830
Mailing Address - Fax:
Practice Address - Street 1:100 ECORSE RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5713
Practice Address - Country:US
Practice Address - Phone:734-482-1034
Practice Address - Fax:734-482-0091
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist