Provider Demographics
NPI:1285980581
Name:MILLER, MATTHEW STEPHEN (CLINICAL PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:STEPHEN
Last Name:MILLER
Suffix:
Gender:M
Credentials:CLINICAL PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 LANCASTER DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1354
Mailing Address - Country:US
Mailing Address - Phone:503-399-1502
Mailing Address - Fax:
Practice Address - Street 1:3791 RICHARDSON RD
Practice Address - Street 2:
Practice Address - City:SCOTTS MILLS
Practice Address - State:OR
Practice Address - Zip Code:97375-9616
Practice Address - Country:US
Practice Address - Phone:503-910-6713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8070183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist