Provider Demographics
NPI:1013548031
Name:ZOTTMAN, MIRANDA KAY (PHARMD)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:KAY
Last Name:ZOTTMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:KAY
Other - Last Name:GILPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1509 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-9229
Mailing Address - Country:US
Mailing Address - Phone:270-465-0501
Mailing Address - Fax:
Practice Address - Street 1:1509 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-9229
Practice Address - Country:US
Practice Address - Phone:270-465-0501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0133201835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist