Healthcare Provider Details

I. General information

NPI: 1770056228
Provider Name (Legal Business Name): MIRANDA HELMERICHS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BLUEMONT AVE
MANHATTAN KS
66502-5093
US

IV. Provider business mailing address

603 N OAK ST
FRANKFORT KS
66427-1353
US

V. Phone/Fax

Practice location:
  • Phone: 785-776-4841
  • Fax:
Mailing address:
  • Phone: 785-221-1811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-14865
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: