Provider Demographics
NPI:1992151591
Name:MILLER, BRADLEY FRANKLIN
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:FRANKLIN
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2725
Mailing Address - Country:US
Mailing Address - Phone:847-853-8042
Mailing Address - Fax:847-853-8091
Practice Address - Street 1:411 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2725
Practice Address - Country:US
Practice Address - Phone:847-853-8042
Practice Address - Fax:847-853-8091
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051024309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist