MEDICARE: MR. MALCOLM MILES 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
1	183500000X	Pharmacist	46194	TX
2	183500000X	Pharmacist	6406	AR

General Provider Information

NPI Number	:	1659686053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MALCOLM MILES RPH

Provider Business Mailing Address
First Line	:	4821 BROADWAY ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-5703
Country	:	US
Telephone Number	:	210-824-0515
Fax Number	:

Provider Business Practice Location Address
First Line	:	4821 BROADWAY ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-5703
Country	:	US
Telephone Number	:	210-824-0515
Fax Number	:

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

Provider Enumeration Date	:	08/10/2010
Last Update Date	:	08/10/2010

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