Provider Demographics
NPI:1932826468
Name:MIRANDA, DEBRA LEIGH (VA00021259)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LEIGH
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:VA00021259
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16107 54TH PL W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-4741
Mailing Address - Country:US
Mailing Address - Phone:425-256-1735
Mailing Address - Fax:
Practice Address - Street 1:3625 148TH ST SW STE B
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-5577
Practice Address - Country:US
Practice Address - Phone:425-742-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA0002129183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician