Provider Demographics
NPI:1427498138
Name:KWAME, MIRIAM (PHARMD)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:KWAME
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 1:1101 WOODRDG CTR DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-1952
Mailing Address - Country:US
Mailing Address - Phone:704-982-2301
Mailing Address - Fax:704-982-2315
Practice Address - Street 1:1101 WOOD RIDGE CENTER DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-1990
Practice Address - Country:US
Practice Address - Phone:704-982-2301
Practice Address - Fax:704-982-2315
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22313183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist