Provider Demographics
NPI:1235260977
Name:MIERA, SONYA REYNE (RPH)
Entity Type:Individual
Prefix:MS
First Name:SONYA
Middle Name:REYNE
Last Name:MIERA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:SONYA
Other - Middle Name:REYNE
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1111 CALLE LA RESOLANA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-5114
Mailing Address - Country:US
Mailing Address - Phone:505-438-9724
Mailing Address - Fax:505-424-3438
Practice Address - Street 1:1301 SILER RD
Practice Address - Street 2:BUILDING A
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-3541
Practice Address - Country:US
Practice Address - Phone:505-476-8354
Practice Address - Fax:505-424-3438
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM5209183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist