Provider Demographics
NPI:1023562345
Name:HOUSE, MILES
Entity Type:Individual
Prefix:
First Name:MILES
Middle Name:
Last Name:HOUSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:UT
Mailing Address - Zip Code:84653-5698
Mailing Address - Country:US
Mailing Address - Phone:801-723-0570
Mailing Address - Fax:801-723-0575
Practice Address - Street 1:118 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:UT
Practice Address - Zip Code:84653-5698
Practice Address - Country:US
Practice Address - Phone:801-723-0570
Practice Address - Fax:801-723-0575
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0015436183500000X
UT8784126-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist