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General NPI Number Information
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NPI Number | 1508349465
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Entity Type | Individual
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Provider Name | MILES DAVID ROBERTS PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/06/2018
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Last Update Date | 08/10/2023
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Provider Practice Location Address
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Address Line | 2111 EXCHANGE ST
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City | ASTORIA
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State | OR
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Zip | 97103-3329
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Country | US
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Telephone | 503-338-4085
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 853
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City | SEASIDE
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State | OR
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Zip | 97138-0853
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Country | US
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Telephone | 801-824-7684
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 10120119-8911
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 10120119-1701
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH0016834
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License Number State | OR
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