Provider Demographics
NPI:1346627502
Name:PULSIPHER, MIRIAM (RPH)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:PULSIPHER
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 1:2930 FREEPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-3843
Mailing Address - Country:US
Mailing Address - Phone:916-942-9575
Mailing Address - Fax:
Practice Address - Street 1:2930 FREEPORT BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-3843
Practice Address - Country:US
Practice Address - Phone:916-942-9575
Practice Address - Fax:833-930-0171
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72373183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist