Healthcare Provider Details

I. General information

NPI: 1871183921
Provider Name (Legal Business Name): RONALD JOE MILES RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 S MAIN ST
LEWISTOWN IL
61542-1565
US

IV. Provider business mailing address

518 S MAIN ST
LEWISTOWN IL
61542-1565
US

V. Phone/Fax

Practice location:
  • Phone: 309-547-3731
  • Fax: 309-547-2040
Mailing address:
  • Phone: 309-547-3731
  • Fax: 309-547-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051029360
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: