Provider Demographics
NPI:1720075344
Name:MIRANDA, NANCY (PHARMD, CPH)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:PHARMD, CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19523 MORDEN BLUSH DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-9084
Mailing Address - Country:US
Mailing Address - Phone:813-558-5000
Mailing Address - Fax:813-558-5018
Practice Address - Street 1:6919 PARKWAY BLVD
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-2909
Practice Address - Country:US
Practice Address - Phone:813-558-5000
Practice Address - Fax:813-558-5018
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS335931835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy