Provider Demographics
NPI:1629666276
Name:ROYALTY, MIRANDA YVONNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:YVONNE
Last Name:ROYALTY
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 1:2511 TRIMMIER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-1910
Mailing Address - Country:US
Mailing Address - Phone:254-634-2370
Mailing Address - Fax:
Practice Address - Street 1:2511 TRIMMIER RD STE 100
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-1910
Practice Address - Country:US
Practice Address - Phone:254-634-2370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist