Provider Demographics
NPI:1013503432
Name:CRAGO, MIRA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MIRA
Middle Name:
Last Name:CRAGO
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 1:40 FRANKLIN VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-0270
Mailing Address - Country:US
Mailing Address - Phone:508-520-4106
Mailing Address - Fax:508-520-3078
Practice Address - Street 1:40 FRANKLIN VILLAGE DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-0270
Practice Address - Country:US
Practice Address - Phone:508-520-4106
Practice Address - Fax:508-520-3078
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist