Provider Demographics
NPI:1881294437
Name:MILES, ROYCE VANDIVER SR (RPH)
Entity type:Individual
Prefix:
First Name:ROYCE
Middle Name:VANDIVER
Last Name:MILES
Suffix:SR
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 1:1010 HIGHWAY 12 W
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-9167
Mailing Address - Country:US
Mailing Address - Phone:662-324-1901
Mailing Address - Fax:662-324-9391
Practice Address - Street 1:1010 HIGHWAY 12 W
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-9167
Practice Address - Country:US
Practice Address - Phone:662-324-1901
Practice Address - Fax:662-324-9391
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-07552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist