Provider Demographics
NPI:1750650446
Name:MCCART, MYRA
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:
Last Name:MCCART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 DEL PRADO BLVD N
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-2765
Mailing Address - Country:US
Mailing Address - Phone:239-458-2204
Mailing Address - Fax:239-458-8704
Practice Address - Street 1:6 DEL PRADO BLVD N
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2765
Practice Address - Country:US
Practice Address - Phone:239-458-2204
Practice Address - Fax:239-458-8704
Is Sole Proprietor?:No
Enumeration Date:2011-12-24
Last Update Date:2011-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 37007183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist