Provider Demographics
NPI:1790712313
Name:HORTON, MIRIAM E (PHARMD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:E
Last Name:HORTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:E
Other - Last Name:WOLTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1005 LABRADOR BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-3228
Mailing Address - Country:US
Mailing Address - Phone:620-544-2500
Mailing Address - Fax:
Practice Address - Street 1:3101 E KANSAS AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-6995
Practice Address - Country:US
Practice Address - Phone:620-275-7557
Practice Address - Fax:620-275-5078
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist