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General NPI Number Information
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NPI Number | 1619059409
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Entity Type | Organization
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Legal Business Name | MIRRA PHARMACY CORP
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 82 E POST RD
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City | WHITE PLAINS
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State | NY
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Zip | 10601-5007
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Country | US
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Telephone | 914-949-7000
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Fax | 914-949-3259
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Provider Business Mailing Address
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Address Line | 82 E POST RD
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City | WHITE PLAINS
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State | NY
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Zip | 10601-5007
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Country | US
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Telephone | 914-949-7000
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Fax | 914-949-3259
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Authorized Official
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Title or Position | PRESIDENT
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Name | RUTH E MIRRA
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Credential |
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Telephone | 914-949-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 022782
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License Number State | NY
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