Healthcare Provider Details

I. General information

NPI: 1295082949
Provider Name (Legal Business Name): MIRANDA HURLEY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 S MAIN ST
SPARTA NC
28675-9643
US

IV. Provider business mailing address

345 DEERFIELD RD
BOONE NC
28607-5009
US

V. Phone/Fax

Practice location:
  • Phone: 336-372-5599
  • Fax: 336-372-6190
Mailing address:
  • Phone: 828-355-3365
  • Fax: 828-264-0543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22527
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: