Provider Demographics
NPI:1407306533
Name:SCHMIDT, MIRANDA J (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:J
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 WYOMING BLVD NE STE 7B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4869
Mailing Address - Country:US
Mailing Address - Phone:505-346-0533
Mailing Address - Fax:505-346-0532
Practice Address - Street 1:7120 WYOMING BLVD NE STE 7B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4869
Practice Address - Country:US
Practice Address - Phone:505-346-0533
Practice Address - Fax:505-346-0532
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist