Provider Demographics
NPI:1518494624
Name:SCHWARTZ, MIRANDA ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:ELIZABETH
Last Name:SCHWARTZ
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 1:4404 VALLEY QUAIL BLVD N
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3757
Mailing Address - Country:US
Mailing Address - Phone:419-303-8051
Mailing Address - Fax:
Practice Address - Street 1:6075 E BROAD ST STE 3
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-5131
Practice Address - Country:US
Practice Address - Phone:614-759-8660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist