Individual
LARRY DAVID MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
1744 SUBURBAN AVE, 0068, SAINT PAUL, MN 55106-6619
(651) 778-0105
Mailing address
1744 SUBURBAN AVE, T-0068, ST. PAUL, MN 55106-6699
(651) 778-0105
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
112134
MN
Other
Enumeration date
12/06/2011
Last updated
12/06/2011
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