Individual
CLARISSA MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
TSAILE MEDICAL CENTER INDIAN RTE 64, TSAILE, AZ 86556
(928) 724-3600
Mailing address
PO BOX C021, TSAILE, AZ 86556-5048
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
S024290
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S024290
ARIZONA STATE BOARD OF PHARMACY
AZ
Enumeration date
05/15/2020
Last updated
05/15/2020
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