Basic Information
| Provider Information | |||||||||
| NPI: | 1720075344 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIRANDA | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHARMD, CPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19523 MORDEN BLUSH DR | ||||||||
| Address2: | |||||||||
| City: | LUTZ | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335589084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8135585000 | ||||||||
| FaxNumber: | 8135585018 | ||||||||
| Practice Location | |||||||||
| Address1: | 6919 PARKWAY BLVD | ||||||||
| Address2: | |||||||||
| City: | LAND O LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346392909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8135585000 | ||||||||
| FaxNumber: | 8135585018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P1200X | PS33593 | FL | Y | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
No ID Information.