Provider Demographics
NPI:1215484043
Name:MILLER, LISA A (PHARM D)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-8408
Mailing Address - Country:US
Mailing Address - Phone:208-788-4970
Mailing Address - Fax:208-788-5791
Practice Address - Street 1:101 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8408
Practice Address - Country:US
Practice Address - Phone:208-788-4970
Practice Address - Fax:208-788-5791
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist