Provider Demographics
NPI:1215092143
Name:MIRACLE, BERNARDINE F (RPH)
Entity type:Individual
Prefix:MS
First Name:BERNARDINE
Middle Name:F
Last Name:MIRACLE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 SECOND ST
Mailing Address - Street 2:APT #2
Mailing Address - City:WHITESBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41858
Mailing Address - Country:US
Mailing Address - Phone:606-633-4488
Mailing Address - Fax:606-633-4849
Practice Address - Street 1:109 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITESBURG
Practice Address - State:KY
Practice Address - Zip Code:41858-7351
Practice Address - Country:US
Practice Address - Phone:606-633-4488
Practice Address - Fax:606-633-4849
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009373183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist