Provider Demographics
NPI:1043068398
Name:PHAN, MILEY NHI (RPH)
Entity type:Individual
Prefix:
First Name:MILEY
Middle Name:NHI
Last Name:PHAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7129 WALL TRIANA HWY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35757-7421
Mailing Address - Country:US
Mailing Address - Phone:256-970-6451
Mailing Address - Fax:
Practice Address - Street 1:7129 WALL TRIANA HWY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35757-7421
Practice Address - Country:US
Practice Address - Phone:256-970-6451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS13535183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician