Provider Demographics
NPI:1053403352
Name:MILLER, JASON J (RPH)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:J
Last Name:MILLER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50436-2152
Mailing Address - Country:US
Mailing Address - Phone:641-581-2132
Mailing Address - Fax:
Practice Address - Street 1:635 HIGHWAY 9 EAST
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:IA
Practice Address - Zip Code:50436-2152
Practice Address - Country:US
Practice Address - Phone:641-585-3931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist