Provider Demographics
NPI:1659686053
Name:MILES, MALCOLM (RPH)
Entity Type:Individual
Prefix:MR
First Name:MALCOLM
Middle Name:
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 1:4821 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5703
Mailing Address - Country:US
Mailing Address - Phone:210-824-0515
Mailing Address - Fax:
Practice Address - Street 1:4821 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5703
Practice Address - Country:US
Practice Address - Phone:210-824-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46194183500000X
AR6406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist