Provider Demographics
NPI:1336745835
Name:DZURKO, MIRANDA GENEVA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:GENEVA
Last Name:DZURKO
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 1:432 BLACKSTONE DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-1715
Mailing Address - Country:US
Mailing Address - Phone:814-460-9369
Mailing Address - Fax:
Practice Address - Street 1:1611 PEACH ST STE 400
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-2123
Practice Address - Country:US
Practice Address - Phone:814-520-8680
Practice Address - Fax:814-520-6386
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP452505183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist