Provider Demographics
NPI:1003427493
Name:MIRACLE, JAMES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:MIRACLE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4371 AL HIGHWAY 169
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36804-0507
Mailing Address - Country:US
Mailing Address - Phone:334-750-1528
Mailing Address - Fax:
Practice Address - Street 1:2015 NORMANDIE DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2711
Practice Address - Country:US
Practice Address - Phone:334-750-1528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21451183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist