Provider Demographics
NPI:1629846357
Name:MIRANDA, BRAYDEN ANTHONY (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRAYDEN
Middle Name:ANTHONY
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 N 34TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-1938
Mailing Address - Country:US
Mailing Address - Phone:425-256-0127
Mailing Address - Fax:
Practice Address - Street 1:3333 S 120TH PL STE 100
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-5134
Practice Address - Country:US
Practice Address - Phone:425-687-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61446167183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist