Provider Demographics
NPI:1619702552
Name:MIRANDA, MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14000 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:JUNO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-1402
Mailing Address - Country:US
Mailing Address - Phone:561-622-9414
Mailing Address - Fax:
Practice Address - Street 1:14000 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:JUNO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-1402
Practice Address - Country:US
Practice Address - Phone:561-622-9414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS67433183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist