Provider Demographics
NPI:1154763092
Name:MILES, STACY (PHARM D)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5254 PILGRIM TRL W
Mailing Address - Street 2:
Mailing Address - City:MOLINO
Mailing Address - State:FL
Mailing Address - Zip Code:32577-9554
Mailing Address - Country:US
Mailing Address - Phone:850-393-0861
Mailing Address - Fax:
Practice Address - Street 1:2040 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-1151
Practice Address - Country:US
Practice Address - Phone:251-867-6838
Practice Address - Fax:251-867-7565
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist