Provider Demographics
NPI:1023591799
Name:MILEY MEDS PHARMACY LLC
Entity type:Organization
Organization Name:MILEY MEDS PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:CLINTON
Authorized Official - Last Name:MILEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:985-256-7222
Mailing Address - Street 1:64288 HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:LA
Mailing Address - Zip Code:70452-3602
Mailing Address - Country:US
Mailing Address - Phone:985-256-7222
Mailing Address - Fax:985-256-7224
Practice Address - Street 1:64288 HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:LA
Practice Address - Zip Code:70452-3602
Practice Address - Country:US
Practice Address - Phone:985-256-7222
Practice Address - Fax:985-256-7224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2206567Medicaid