Provider Demographics
NPI:1861820367
Name:MILES, JENNIFER CHARBONNET (RPH, BPHARM)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CHARBONNET
Last Name:MILES
Suffix:
Gender:F
Credentials:RPH, BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 RICHMOND AVE
Mailing Address - Street 2:SUITE 259
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-4925
Mailing Address - Country:US
Mailing Address - Phone:713-636-3261
Mailing Address - Fax:713-636-9636
Practice Address - Street 1:10700 RICHMOND AVE
Practice Address - Street 2:SUITE 259
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-4925
Practice Address - Country:US
Practice Address - Phone:713-636-3261
Practice Address - Fax:713-636-9636
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist