Provider Demographics
NPI:1710254578
Name:MILES, CHARLES J
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:MILES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 ALLEBACH RD
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-5875
Mailing Address - Country:US
Mailing Address - Phone:610-222-0794
Mailing Address - Fax:
Practice Address - Street 1:30 W RIDGE PIKE
Practice Address - Street 2:
Practice Address - City:LIMERICK
Practice Address - State:PA
Practice Address - Zip Code:19468-1712
Practice Address - Country:US
Practice Address - Phone:610-454-7295
Practice Address - Fax:610-489-4379
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARPI005482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist