Provider Demographics
NPI:1902180615
Name:LILES, ROBERT S (BSPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:S
Last Name:LILES
Suffix:
Gender:M
Credentials:BSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 SUNNY MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-0414
Mailing Address - Country:US
Mailing Address - Phone:901-383-8639
Mailing Address - Fax:
Practice Address - Street 1:4201 SUNNY MEADOWS RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38135-0414
Practice Address - Country:US
Practice Address - Phone:901-383-8639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC4693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist