Provider Demographics
NPI:1902182678
Name:ZICCARDI, MIRANDA KAY (PHARMD)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:KAY
Last Name:ZICCARDI
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 1:2650 RM 620
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5530
Mailing Address - Country:US
Mailing Address - Phone:512-733-6361
Mailing Address - Fax:
Practice Address - Street 1:2650 RM 620
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5530
Practice Address - Country:US
Practice Address - Phone:512-733-6361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist