Individual
MILES DAVID ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
2111 EXCHANGE ST, ASTORIA, OR 97103-3329
(503) 338-4085
Mailing address
PO BOX 853, SEASIDE, OR 97138-0853
(801) 824-7684
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
10120119-1701
UT
183500000X
Pharmacist
10120119-8911
UT
183500000X
Pharmacist
Primary
RPH0016834
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10120119-1701
DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING PHARMACIST LICENSE
UT
01
—
10120119-8911
DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING CONTROLLED SUBSTANCE LICENSE
UT
01
—
RPH0016834
OREGON BOARD OF PHARMACY PHARMACIST LICENSE
OR
Enumeration date
09/06/2018
Last updated
08/10/2023
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