Provider Demographics
NPI:1396719118
Name:MILLER, LATASHA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LATASHA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10004 BAYWATER BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-6906
Mailing Address - Country:US
Mailing Address - Phone:719-660-4469
Mailing Address - Fax:
Practice Address - Street 1:2285 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2342
Practice Address - Country:US
Practice Address - Phone:407-518-5004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND48541835P1200X
FLPS341781835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy