Provider Demographics
NPI:1689818965
Name:VONLOGAN, MILES SCOTT (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MILES
Middle Name:SCOTT
Last Name:VONLOGAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S VAN BUREN RD
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5026
Mailing Address - Country:US
Mailing Address - Phone:336-623-9026
Mailing Address - Fax:
Practice Address - Street 1:109 S VAN BUREN RD
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5026
Practice Address - Country:US
Practice Address - Phone:336-623-9026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18665183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC18665OtherPHARMACIST LICENSE NUMBER