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General NPI Number Information
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NPI Number | 1679764443
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Entity Type | Organization
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Legal Business Name | MIRACLE PHARMACY INC.
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 11/13/2008
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Provider Practice Location Address
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Address Line | 2490 HONOLULU AVE # 140-B
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City | MONTROSE
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State | CA
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Zip | 91020-1800
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Country | US
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Telephone | 818-541-0555
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Fax |
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Provider Business Mailing Address
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Address Line | 2490 HONOLULU AVE # 140-B
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City | MONTROSE
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State | CA
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Zip | 91020-1800
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Country | US
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Telephone | 818-541-0555
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | NANCY NAZIK SIMONIAN
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Credential |
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Telephone | 818-541-0555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 48338
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License Number State | CA
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