=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023724473
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIRANDA SMITH PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2023
-----------------------------------------------------
Last Update Date | 01/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 BENNETT DR
-----------------------------------------------------
City | CARIBOU
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04736-2022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-498-8735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17 HARDISON AVE E
-----------------------------------------------------
City | CARIBOU
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04736-1630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PR71101
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------