Provider Demographics
NPI:1194320515
Name:MILLER, LAINIE LOUISE (RPH)
Entity type:Individual
Prefix:
First Name:LAINIE
Middle Name:LOUISE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LAINIE
Other - Middle Name:LOUISE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSPHARM
Mailing Address - Street 1:2313 S MOUNT PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-1811
Mailing Address - Country:US
Mailing Address - Phone:312-771-0543
Mailing Address - Fax:315-732-7890
Practice Address - Street 1:2313 S MOUNT PROSPECT RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-1811
Practice Address - Country:US
Practice Address - Phone:312-771-0543
Practice Address - Fax:315-732-7890
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051038748183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist