Provider Demographics
NPI:1548664618
Name:ROONEY, MILES RYAN (PHARMD)
Entity type:Individual
Prefix:
First Name:MILES
Middle Name:RYAN
Last Name:ROONEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5017 W VILLA CIR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4787
Mailing Address - Country:US
Mailing Address - Phone:307-679-0738
Mailing Address - Fax:
Practice Address - Street 1:1840 DELL RANGE BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4949
Practice Address - Country:US
Practice Address - Phone:307-635-9108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3777183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist