Healthcare Provider Details

I. General information

NPI: 1023591799
Provider Name (Legal Business Name): MILEY MEDS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 07/27/2024
Certification Date: 07/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64288 HIGHWAY 41
PEARL RIVER LA
70452-3602
US

IV. Provider business mailing address

64288 HIGHWAY 41
PEARL RIVER LA
70452-3602
US

V. Phone/Fax

Practice location:
  • Phone: 985-256-7222
  • Fax: 985-256-7224
Mailing address:
  • Phone: 985-256-7222
  • Fax: 985-256-7224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. CLARENCE CLINTON MILEY JR.
Title or Position: OWNER/PIC
Credential: RPH.
Phone: 985-256-7222