Provider Demographics
NPI:1962722603
Name:MILLER, MANDEL M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MANDEL
Middle Name:M
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1674 CLEAR VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-2011
Mailing Address - Country:US
Mailing Address - Phone:310-271-7411
Mailing Address - Fax:
Practice Address - Street 1:300 N CANON DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4705
Practice Address - Country:US
Practice Address - Phone:310-273-3561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA31161OtherSTATE LICENSE