Provider Demographics
NPI:1043354566
Name:MIRANDA, PAMELA J (BS RPH)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:J
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:BS RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 N HARWINTON AVE
Mailing Address - Street 2:
Mailing Address - City:TERRYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06786-4306
Mailing Address - Country:US
Mailing Address - Phone:860-679-7915
Mailing Address - Fax:860-679-8015
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1956
Practice Address - Country:US
Practice Address - Phone:860-679-7920
Practice Address - Fax:860-679-8020
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8373183500000X
MEPR4613183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist