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General NPI Number Information
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NPI Number | 1700556644
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Entity Type | Individual
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Provider Name | MIRANDA NEAL HAISLIP
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Gender | Female
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Dates
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Enumeration Date | 09/13/2021
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Last Update Date | 09/13/2021
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Provider Practice Location Address
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Address Line | 2150 US HIGHWAY 13 S
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City | AHOSKIE
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State | NC
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Zip | 27910-9481
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Country | US
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Telephone | 252-332-3545
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Fax |
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Provider Business Mailing Address
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Address Line | 7384 AURELIAN SPRINGS RD
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City | HALIFAX
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State | NC
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Zip | 27839-9235
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Country | US
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Telephone | 252-532-0551
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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 | 30792
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License Number State | NC
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