Provider Demographics
NPI:1114473717
Name:CONARD, MIRANDA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:CONARD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 S CLARIZZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-5588
Mailing Address - Country:US
Mailing Address - Phone:812-353-3096
Mailing Address - Fax:812-353-3070
Practice Address - Street 1:995 S CLARIZZ BLVD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-5588
Practice Address - Country:US
Practice Address - Phone:812-353-3096
Practice Address - Fax:812-353-3070
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26026099A1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care