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General NPI Number Information
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NPI Number | 1043354566
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Entity Type | Individual
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Provider Name | PAMELA J MIRANDA BS RPH
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Gender | Female
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 263 FARMINGTON AVE
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City | FARMINGTON
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State | CT
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Zip | 06032-1956
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Country | US
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Telephone | 860-679-7920
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Fax | 860-679-8020
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Provider Business Mailing Address
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Address Line | 174 N HARWINTON AVE
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City | TERRYVILLE
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State | CT
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Zip | 06786-4306
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Country | US
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Telephone | 860-679-7915
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Fax | 860-679-8015
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 8373
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PR4613
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License Number State | ME
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