Provider Demographics
NPI:1154650646
Name:POWELL, MYLES L (RPH)
Entity Type:Individual
Prefix:
First Name:MYLES
Middle Name:L
Last Name:POWELL
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 1:1924 W SPRING RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1220
Mailing Address - Country:US
Mailing Address - Phone:847-259-0905
Mailing Address - Fax:
Practice Address - Street 1:1924 W SPRING RIDGE DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1220
Practice Address - Country:US
Practice Address - Phone:847-259-0905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-031119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051-031119OtherPHARMACIST LICENSE #