Provider Demographics
NPI:1548991151
Name:MILLER, KATHY JO (RPH)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:JO
Last Name:MILLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 LAUREL RUN RD
Mailing Address - Street 2:
Mailing Address - City:CARMICHAELS
Mailing Address - State:PA
Mailing Address - Zip Code:15320-2543
Mailing Address - Country:US
Mailing Address - Phone:304-288-2122
Mailing Address - Fax:
Practice Address - Street 1:3040 UNIVERSITY AVE STE 1400
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3381
Practice Address - Country:US
Practice Address - Phone:304-285-7216
Practice Address - Fax:304-598-4034
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0004620183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVRP0004620OtherREGISTERED PHARMACIST LICENSE