# MILLER PROFESSIONAL PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518936525
- **Authorized official:** MR. CHARLES MICHAEL MILLER RPH (PRESIDENT)
- **Authorized official phone:** (816) 858-2400

## Contact information

- **Practice address:** 2703 RUNNING HORSE RD STE 1A, \#1877, PLATTE CITY, MO 64079-7707
- **Practice address phone:** (816) 858-2400
- **Practice address fax:** (816) 858-5051
- **Mailing address:** PO BOX 1877, 2703 RUNNING HORSE RD STE 1A, PLATTE CITY, MO 64079-1877
- **Mailing address phone:** (816) 858-2400
- **Mailing address fax:** (816) 858-5051

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | PS 005109 | MO | — |
| 333600000X | Pharmacy | PS005109 | MO | Yes |

## Other

- **Enumeration date:** 03/14/2006
- **Last updated:** 10/06/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 601155609 | — | MO |