Provider Demographics
NPI:1932086782
Name:HIRMEZ, MIRANDA S (PHARMD)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:S
Last Name:HIRMEZ
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 1:4579 BIRD OF PARADISE LN
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-6877
Mailing Address - Country:US
Mailing Address - Phone:619-540-2643
Mailing Address - Fax:
Practice Address - Street 1:9665 CAMPO RD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-1228
Practice Address - Country:US
Practice Address - Phone:619-466-4051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist