Provider Demographics
NPI:1750865010
Name:FRANKE, MIRANDA NOELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:NOELLE
Last Name:FRANKE
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 1:60435 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-4710
Mailing Address - Country:US
Mailing Address - Phone:631-871-3108
Mailing Address - Fax:
Practice Address - Street 1:19 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SHELTER ISLAND HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11965-2000
Practice Address - Country:US
Practice Address - Phone:631-749-0445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064757183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist