Provider Demographics
NPI:1215159546
Name:MILLER, LARRY LEROY (RPH)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:LEROY
Last Name:MILLER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6744 NIGHTINGALE DR
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-9081
Mailing Address - Country:US
Mailing Address - Phone:989-939-7872
Mailing Address - Fax:
Practice Address - Street 1:825 N CENTER
Practice Address - Street 2:OTSEGO MEMORIAL HOSPITAL PHARMACY
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735
Practice Address - Country:US
Practice Address - Phone:989-731-2163
Practice Address - Fax:989-731-2162
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist