Provider Demographics
NPI:1154032555
Name:KILZI, MIRANDA (PHARMD)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:KILZI
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 1:27702 CROWN VALLEY PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-0608
Mailing Address - Country:US
Mailing Address - Phone:949-364-1430
Mailing Address - Fax:
Practice Address - Street 1:27702 CROWN VALLEY PKWY STE 1
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-0608
Practice Address - Country:US
Practice Address - Phone:949-364-1430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH87412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist