Provider Demographics
NPI:1558802207
Name:MILES CONNECT LLC
Entity Type:Organization
Organization Name:MILES CONNECT LLC
Other - Org Name:RED APPLE INTERACTIVE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IYAMU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-517-8122
Mailing Address - Street 1:165 LAKESTONE PKWY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-5427
Mailing Address - Country:US
Mailing Address - Phone:770-517-8122
Mailing Address - Fax:
Practice Address - Street 1:1570 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4703
Practice Address - Country:US
Practice Address - Phone:770-518-8120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0103493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy