Provider Demographics
NPI:1477272193
Name:MURRAY, MIRANDA N (PHARMD)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:N
Last Name:MURRAY
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 1:2550 BLACKMON DR APT 2101
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6220
Mailing Address - Country:US
Mailing Address - Phone:225-362-9976
Mailing Address - Fax:
Practice Address - Street 1:3740 CASCADE RD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2108
Practice Address - Country:US
Practice Address - Phone:404-472-1949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist