MEDICARE: DR. MIRANDA HURLEY PHARMD

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	43546	SC

General Provider Information

NPI Number	:	1932836558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIRANDA HURLEY PHARMD

Provider Business Mailing Address
First Line	:	1304 VENNING RD
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-9403
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1981 RIVIERA DR
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-7401
Country	:	US
Telephone Number	:	843-849-1515
Fax Number	:

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

Provider Enumeration Date	:	08/03/2022
Last Update Date	:	08/05/2022

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