Active NPI
Shane Michael Miller, PHARMD
- Pharmacist
- Macomb, IL
National Provider Identifier
1114201183
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051.293200
- Practice address
- 533 E Grant St
Macomb, IL 61455-3313 - Phone
- (309) 575-4679
- Fax
- (309) 836-1910
- NPI assigned
- Oct 7, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051.293200 | IL | Primary |
Addresses
Primary practice location
533 E Grant St
Macomb, IL 61455-3313
Mailing address
1 Hickory GRV
Macomb, IL 61455-1108
Phone (309) 360-1202
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051.293200 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Moreland and Devitt, Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- Rushville, IL
- NPI 1235249756
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1760659200000",
"number": "1114201183",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 HICKORY GRV",
"city": "MACOMB",
"state": "IL",
"postal_code": "614551108",
"telephone_number": "309-360-1202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "533 E GRANT ST",
"city": "MACOMB",
"state": "IL",
"postal_code": "614553313",
"telephone_number": "309-575-4679",
"fax_number": "309-836-1910"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "SHANE",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-10-07",
"last_updated": "2025-10-17",
"certification_date": "2025-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051.293200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Macomb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.