Healthcare Provider Details

I. General information

NPI: 1770525875
Provider Name (Legal Business Name): WESLEY A MILEY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 E NORTHSIDE DR
CLINTON MS
39056-3659
US

IV. Provider business mailing address

11 SOUTHERN OAKS DR
CLINTON MS
39056-9406
US

V. Phone/Fax

Practice location:
  • Phone: 601-924-8935
  • Fax: 601-924-9127
Mailing address:
  • Phone: 601-924-3193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE05581
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: