Provider Demographics
NPI:1457662546
Name:MCCONNELL, MIRANDA E (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:E
Last Name:MCCONNELL
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 1:766 MOCCASIN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:GATE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:24251-5239
Mailing Address - Country:US
Mailing Address - Phone:276-386-7275
Mailing Address - Fax:
Practice Address - Street 1:2790 E STONE DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-5849
Practice Address - Country:US
Practice Address - Phone:423-288-9286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27079183500000X
VA0202207555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist