Provider Demographics
NPI:1629637160
Name:ARNOLD, MIRIAM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:
Other - Last Name:RAJAB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13460 S ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-5270
Mailing Address - Country:US
Mailing Address - Phone:815-577-2605
Mailing Address - Fax:
Practice Address - Street 1:13460 S ROUTE 59
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-5270
Practice Address - Country:US
Practice Address - Phone:815-577-2605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-09
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.302387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051.302387OtherILDFPR