Healthcare Provider Details

I. General information

NPI: 1417355967
Provider Name (Legal Business Name): TALIA MILES PHARMD, BCPS, BCPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2014
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 W 10TH ST PHARMACY DEPT (119)
INDIANAPOLIS IN
46202-2803
US

IV. Provider business mailing address

1481 W 10TH ST PHARMACY DEPT (119)
INDIANAPOLIS IN
46202-2803
US

V. Phone/Fax

Practice location:
  • Phone: 317-554-0000
  • Fax:
Mailing address:
  • Phone: 317-554-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number26024106A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: