MEDICARE: ENRIQUE MIRANDA MEDINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	10526	NV

General Provider Information

NPI Number	:	1194484857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENRIQUE MIRANDA MEDINA

Provider Business Mailing Address
First Line	:	3328 RED LODGE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7533
Country	:	US
Telephone Number	:	702-524-4948
Fax Number	:

Provider Business Practice Location Address
First Line	:	3602 E BONANZA RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-2161
Country	:	US
Telephone Number	:	702-438-1091
Fax Number	:	702-438-0742

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2021
Last Update Date	:	12/09/2021

Similar Medicare Providers

1871990606 — SMITHS FOOD & DRUG CENTERS INC
Practice Location Address:

3602 E BONANZA RD
LAS VEGAS, NV
89110-2161

Practice Phone: 702-438-1091
Practice Fax: 702-438-0742

1033740790 — MARIA PERPETUA DE LA PAZ RPH
Practice Location Address:

3602 E BONANZA RD
LAS VEGAS, NV
89110-2161

Practice Phone: 702-438-1091
Practice Fax: 702-438-0742

1184920779 — MR. JAMAAL LAPREE MOORE
Practice Location Address:

8101 W FLAMINGO RD UNIT 2161
LAS VEGAS, NV
89147-7420

Practice Phone: 702-572-8567
Practice Fax:

1295019891 — BRANDY SHANEY BRANTLEY
Practice Location Address:

5400 MOUNTAIN VISTA ST , #1114
LAS VEGAS, NV
89120-2161

Practice Phone: 313-539-5539
Practice Fax:

1093105090 — CAROLINE R SMITH OTR/L
Practice Location Address:

705 TWIN LAKES DR
LAS VEGAS, NV
89107-2161

Practice Phone: 702-378-2118
Practice Fax:

1568847762 — DEREK LEE
Practice Location Address:

5400 MOUNTAIN VISTA ST , APT 1421
LAS VEGAS, NV
89120-2161

Practice Phone: 510-754-9611
Practice Fax:

Directions to “ ENRIQUE MIRANDA MEDINA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.