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General NPI Number Information
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NPI Number | 1144606930
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Entity Type | Individual
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Provider Name | MIRANDA NICOLE BERRY PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/04/2015
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 1500 E SUNSHINE SUITE 148
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City | SPRINGFIELD
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State | MO
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Zip | 65804
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Country | US
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Telephone | 417-520-0607
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 E SUNSHINE SUITE 148
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City | SPRINGFIELD
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State | MO
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Zip | 65804
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Country | US
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Telephone | 417-520-0607
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Fax |
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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 | 1-16725
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License Number State | KS
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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 | 2024032700
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License Number State | MO
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