Provider Demographics
NPI:1336248376
Name:MILES DRUG COMPANY
Entity type:Organization
Organization Name:MILES DRUG COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-796-2815
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:122 N EAST ST
Mailing Address - City:ATLANTA
Mailing Address - State:TX
Mailing Address - Zip Code:75551
Mailing Address - Country:US
Mailing Address - Phone:903-796-2815
Mailing Address - Fax:903-796-0821
Practice Address - Street 1:122 N EAST ST
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:TX
Practice Address - Zip Code:75551
Practice Address - Country:US
Practice Address - Phone:903-796-2815
Practice Address - Fax:903-796-0821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11264183500000X
TX012823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4503290OtherNABP
TX110120Medicaid