=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871183921
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RONALD JOE MILES RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2021
-----------------------------------------------------
Last Update Date | 01/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 518 S MAIN ST
-----------------------------------------------------
City | LEWISTOWN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61542-1565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-547-3731
-----------------------------------------------------
Fax | 309-547-2040
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 518 S MAIN ST
-----------------------------------------------------
City | LEWISTOWN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61542-1565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-547-3731
-----------------------------------------------------
Fax | 309-547-2040
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 051029360
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------