Provider Demographics
NPI:1699108670
Name:JONES, MIRANDA L (PHARMD)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:L
Last Name:JONES
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 1:15G STARRETT DR
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6563
Mailing Address - Country:US
Mailing Address - Phone:207-338-0441
Mailing Address - Fax:
Practice Address - Street 1:15G STARRETT DR
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6563
Practice Address - Country:US
Practice Address - Phone:207-338-0441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR12905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPR12905OtherRPH LICENSE