Provider Demographics
NPI:1902448699
Name:MILLER, RYAN JEFFREY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JEFFREY
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 1:165 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-2584
Mailing Address - Country:US
Mailing Address - Phone:716-400-3226
Mailing Address - Fax:
Practice Address - Street 1:3040 EVANS ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3176
Practice Address - Country:US
Practice Address - Phone:252-355-6450
Practice Address - Fax:252-378-3751
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066305183500000X
NC29466183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist