Provider Demographics
NPI:1609177682
Name:CROWN, MIRANDA L (PHARMD)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:L
Last Name:CROWN
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 1:1900 NE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3854
Mailing Address - Country:US
Mailing Address - Phone:541-389-1717
Mailing Address - Fax:
Practice Address - Street 1:1900 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3854
Practice Address - Country:US
Practice Address - Phone:541-389-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist