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General NPI Number Information
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NPI Number | 1558802207
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Entity Type | Organization
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Legal Business Name | MILES CONNECT LLC
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Dates
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Enumeration Date | 03/14/2017
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Last Update Date | 03/14/2017
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Provider Practice Location Address
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Address Line | 1570 HOLCOMB BRIDGE RD SUITE 200
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City | ROSWELL
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State | GA
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Zip | 30076-4703
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Country | US
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Telephone | 770-518-8120
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Fax |
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Provider Business Mailing Address
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Address Line | 165 LAKESTONE PKWY
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City | WOODSTOCK
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State | GA
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Zip | 30188-5427
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Country | US
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Telephone | 770-517-8122
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EMMANUEL IYAMU
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Credential |
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Telephone | 770-517-8122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE010349
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License Number State | GA
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