MEDICARE: MILES GILMAN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	19129	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19129	OTHER	FL	FLORIDA BOARD OF PHARMACY

General Provider Information

NPI Number	:	1154940716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILES GILMAN PHARMD

Provider Business Mailing Address
First Line	:	160 SW 12TH AVE STE 101D
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-3114
Country	:	US
Telephone Number	:	888-327-2233
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 SW 12TH AVE
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-3119
Country	:	US
Telephone Number	:	888-327-2233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2020
Last Update Date	:	11/27/2023

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