Provider Demographics
NPI:1730213356
Name:MILES, RODGER A JR (REGISTERD PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:RODGER
Middle Name:A
Last Name:MILES
Suffix:JR
Gender:M
Credentials:REGISTERD PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 GROOVER DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3808
Mailing Address - Country:US
Mailing Address - Phone:770-214-8910
Mailing Address - Fax:
Practice Address - Street 1:1601 MAPLE ST
Practice Address - Street 2:HEALTH SERVICES (PHARMACY)
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30118-0001
Practice Address - Country:US
Practice Address - Phone:678-839-0647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0169031835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy