Healthcare Provider Details

I. General information

NPI: 1144222852
Provider Name (Legal Business Name): ELIZABETH MARIE MILES PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 KENNEDY CIR
MEDINA NY
14103-1075
US

IV. Provider business mailing address

105 KENNEDY CIR
MEDINA NY
14103-1075
US

V. Phone/Fax

Practice location:
  • Phone: 585-798-4580
  • Fax: 585-798-4580
Mailing address:
  • Phone: 585-798-4580
  • Fax: 585-798-4580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number048732
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: