Healthcare Provider Details

I. General information

NPI: 1144606930
Provider Name (Legal Business Name): MIRANDA NICOLE BERRY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIRANDA NICOLE NAYLOR PHARMD

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E SUNSHINE SUITE 148
SPRINGFIELD MO
65804
US

IV. Provider business mailing address

1500 E SUNSHINE SUITE 148
SPRINGFIELD MO
65804
US

V. Phone/Fax

Practice location:
  • Phone: 417-520-0607
  • Fax:
Mailing address:
  • Phone: 417-520-0607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-16725
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2024032700
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: