Provider Demographics
NPI:1861538324
Name:MILLER, KAREN R (RPH)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:R
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 1:61 CAROLINE RD
Mailing Address - Street 2:
Mailing Address - City:GOWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14070-1013
Mailing Address - Country:US
Mailing Address - Phone:716-532-5174
Mailing Address - Fax:716-532-1808
Practice Address - Street 1:31 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GOWANDA
Practice Address - State:NY
Practice Address - Zip Code:14070-1305
Practice Address - Country:US
Practice Address - Phone:716-532-1700
Practice Address - Fax:716-532-1808
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036898183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03379191Medicaid
NY6539480001Medicare UPIN