Provider Demographics
NPI:1033871298
Name:MILES, CHRISTINE MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:MILES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:HEINES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:155 REAGAN DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40071-7509
Mailing Address - Country:US
Mailing Address - Phone:502-649-3232
Mailing Address - Fax:
Practice Address - Street 1:155 REAGAN DR
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40071-7509
Practice Address - Country:US
Practice Address - Phone:502-649-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist