Provider Demographics
NPI:1902136039
Name:MILLER, HOWARD QUINCY (RPH)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:QUINCY
Last Name:MILLER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9230 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-8803
Mailing Address - Country:US
Mailing Address - Phone:480-380-0087
Mailing Address - Fax:480-380-2745
Practice Address - Street 1:9230 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-8803
Practice Address - Country:US
Practice Address - Phone:480-380-0087
Practice Address - Fax:480-380-2745
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS013348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist