MEDICARE: MR. CLARENCE CLINTON MILEY JR. RPH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	16329	LA

General Provider Information

NPI Number	:	1336391465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CLARENCE CLINTON MILEY JR. RPH.

Provider Business Mailing Address
First Line	:	64288 HIGHWAY 41
Second Line	:
City	:	PEARL RIVER
State	:	LA
Zip	:	70452-3602
Country	:	US
Telephone Number	:	985-256-7222
Fax Number	:	985-256-7224

Provider Business Practice Location Address
First Line	:	64288 HIGHWAY 41
Second Line	:
City	:	PEARL RIVER
State	:	LA
Zip	:	70452-3602
Country	:	US
Telephone Number	:	985-256-7222
Fax Number	:	985-256-7224

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	07/27/2024

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