Gary A Miller, R.PH.
Individual provider Active NPI Pharmacist · Little Chute, WI
NPI 1487930830 · NPPES record last updated Oct 31, 2011
Key facts
- NPI
- 1487930830
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 09344040 (WI)
- Practice address
- 219 W Main St
Little Chute, WI 54140-1751 - Phone
- (920) 687-6193
- NPI assigned
- Oct 31, 2011
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 09344040 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past |
Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 09344040 | WI | Yes |
Addresses
Primary practice location
219 W Main St
Little Chute, WI 54140-1751
Mailing address
219 W Main St
Little Chute, WI 54140-1751
Phone (920) 687-6193
Other providers in Little Chute, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 31, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.