Provider Demographics
NPI:1124624564
Name:MILLER, JEREMY (RPH, PHARMD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SHOPRITE PHARMACY DEPARTMENT
Mailing Address - Street 2:297 ROUTE 72 WEST
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SHOPRITE PHARMACY DEPARTMENT
Practice Address - Street 2:297 ROUTE 72 WEST
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050
Practice Address - Country:US
Practice Address - Phone:609-597-0092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02753400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist