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NPI Code Detail

MEDICARE: MILES ABOVE RPH

MEDICARE: MILES ABOVE RPH
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
1261QH0100XHealth Service Clinic/CenterPS46979FL

General Provider Information

NPI Number : 1538427166
Entity Type Code : Organization
Provider Name (Legal Business Name) : MILES ABOVE RPH
Provider Business Mailing Address
First Line : 275 JOHN KNOX RD
Second Line : #JJ204
City : TALLAHASSEE
State : FL
Zip : 32303-6614
Country : US
Telephone Number : 904-699-6478
Fax Number :
Provider Business Practice Location Address
First Line : 1909 HILLBROOKE TRL
Second Line : SUITE 1
City : TALLAHASSEE
State : FL
Zip : 32311-7901
Country : US
Telephone Number : 850-222-1963
Fax Number : 850-224-9356
Authorized Official
Title or Position : OWNER
Name : DR. JOVAN MILES
Credential : PHARM.D.
Telephone Number : 904-699-6478
Provider Enumeration Date : 05/02/2012
Last Update Date : 05/02/2012

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