Provider Demographics
NPI:1144834862
Name:SPILLETT, MIRANDA JULIA
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:JULIA
Last Name:SPILLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7051 NIGHTINGALE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-7821
Mailing Address - Country:US
Mailing Address - Phone:419-290-5740
Mailing Address - Fax:
Practice Address - Street 1:5890 MONROE ST
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2200
Practice Address - Country:US
Practice Address - Phone:419-882-5860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03440151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist