Provider Demographics
NPI:1518680552
Name:MILJAN, TAMMY (CPHT)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:MILJAN
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19770 WILLIAMSON ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4088
Mailing Address - Country:US
Mailing Address - Phone:586-872-3015
Mailing Address - Fax:
Practice Address - Street 1:19770 WILLIAMSON ST
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-4088
Practice Address - Country:US
Practice Address - Phone:586-872-3015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303006935183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician