Provider Demographics
NPI:1427340827
Name:MILES, JENNY B (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:B
Last Name:MILES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 COPPER RUN BLVD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-2221
Mailing Address - Country:US
Mailing Address - Phone:859-223-0701
Mailing Address - Fax:
Practice Address - Street 1:3735 PALOMAR CENTRE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1147
Practice Address - Country:US
Practice Address - Phone:859-223-0701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011880183500000X
IN26021358A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist