Provider Demographics
NPI:1306142542
Name:MILLER, ALISON R
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 A AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3037
Mailing Address - Country:US
Mailing Address - Phone:503-675-4486
Mailing Address - Fax:503-675-4488
Practice Address - Street 1:401 A AVE
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3037
Practice Address - Country:US
Practice Address - Phone:503-675-4486
Practice Address - Fax:503-675-4488
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-06
Last Update Date:2015-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9013183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist