Provider Demographics
NPI:1396331195
Name:CHAMBERS, MIYAH RENEE
Entity type:Individual
Prefix:
First Name:MIYAH
Middle Name:RENEE
Last Name:CHAMBERS
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 1:621 PEACEFUL VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-7506
Mailing Address - Country:US
Mailing Address - Phone:317-501-8032
Mailing Address - Fax:
Practice Address - Street 1:621 PEACEFUL VIEW DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-7506
Practice Address - Country:US
Practice Address - Phone:317-501-8032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN67033165A183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician