Provider Demographics
NPI:1154528214
Name:MILLER, RENAY (BSC(PHARMACY))
Entity type:Individual
Prefix:MRS
First Name:RENAY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:BSC(PHARMACY)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4290 LAKE FOREST DR E
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-9680
Mailing Address - Country:US
Mailing Address - Phone:734-996-0079
Mailing Address - Fax:
Practice Address - Street 1:1 WAHOO AVE
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-2324
Practice Address - Country:US
Practice Address - Phone:860-694-2590
Practice Address - Fax:860-694-2590
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13912183500000X
VA0202012792183500000X
MI5302032594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist