Provider Demographics
NPI:1275788267
Name:NEAL, MIRANDA TY (PHARM TECH)
Entity Type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:TY
Last Name:NEAL
Suffix:
Gender:F
Credentials:PHARM TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S VALENTINE ST APT C
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5753
Mailing Address - Country:US
Mailing Address - Phone:501-425-8452
Mailing Address - Fax:
Practice Address - Street 1:500 S VALENTINE ST APT C
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5753
Practice Address - Country:US
Practice Address - Phone:501-425-8452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician