Provider Demographics
NPI:1871183921
Name:MILES, RONALD JOE (RPH)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:JOE
Last Name:MILES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:61542-1565
Mailing Address - Country:US
Mailing Address - Phone:309-547-3731
Mailing Address - Fax:309-547-2040
Practice Address - Street 1:518 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:IL
Practice Address - Zip Code:61542-1565
Practice Address - Country:US
Practice Address - Phone:309-547-3731
Practice Address - Fax:309-547-2040
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051029360183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist