Provider Demographics
NPI:1306881529
Name:MILLERS PHARMACY
Entity type:Organization
Organization Name:MILLERS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-395-2127
Mailing Address - Street 1:100 E DALLAS AVE
Mailing Address - Street 2:
Mailing Address - City:COOPER
Mailing Address - State:TX
Mailing Address - Zip Code:75432-2043
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 E DALLAS AVE
Practice Address - Street 2:
Practice Address - City:COOPER
Practice Address - State:TX
Practice Address - Zip Code:75432-2043
Practice Address - Country:US
Practice Address - Phone:903-395-2127
Practice Address - Fax:903-395-3160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142623Medicaid
4516297OtherOTHER ID NUMBER-COMMERCIAL NUMBER
TX142623Medicaid