MEDICARE: DR. NANCY MIRANDA PHARMD, CPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	PS33593	FL

General Provider Information

NPI Number	:	1720075344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY MIRANDA PHARMD, CPH

Provider Business Mailing Address
First Line	:	19523 MORDEN BLUSH DR
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33558-9084
Country	:	US
Telephone Number	:	813-558-5000
Fax Number	:	813-558-5018

Provider Business Practice Location Address
First Line	:	6919 PARKWAY BLVD
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-2909
Country	:	US
Telephone Number	:	813-558-5000
Fax Number	:	813-558-5018

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	07/08/2007

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