Mira Surjanto is a Pharmacist in Vallejo, California. Mira Surjanto practices all healthcare services and medical treatments related to Pharmacist. The NPI Number for Mira Surjanto is 1124110705. The last update date is 2007-07-08.
Mira Surjanto's current location address is 975 Sereno Dr, Vallejo, California. You can contact this provider via phone number 7076512584. The mailing address for Mira Surjanto is 975 Sereno Dr, Vallejo, California. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Mira Surjanto |
|---|---|
| Address | 975 Sereno Dr, Vallejo, California |
| Phone Number | 7076512584 |
| Fax Number | |
| Sole Proprietor | N |
| Credentials | PHARM.D. |
NPI Number Detail
| NPI Number | 1124110705 |
|---|---|
| Provider Enumeration Date | 2006-09-29 |
| Last Updated Date | 2007-07-08 |
Provider Mailing Address Detail
| Address | 975 Sereno Dr |
|---|---|
| City | Vallejo |
| State | California (CA) |
| Post Code | 945892441 |
| Phone Number | 7076512584 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Pharmacist |
|---|---|
| Taxonomy | 183500000X |
| Licence No | 51280 |
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Definition: An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or m |
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Post Comment/ Review Below
What is the Mira Surjanto's 1124110705?
The Mira Surjanto's NPI (National Provider Identifier) Number is 1124110705. This unique 10-digit identification number is assigned to health care providers by the Centers for Medicare & Medicaid Services (CMS).
Could you please share the complete physical address where Mira Surjanto is geographically located?
The Mira Surjanto is physically situated at the following location: 975 Sereno Dr, Vallejo, CA, 945892441.
What is Mira Surjanto's primary area of medical expertise, and what taxonomy classification code corresponds to this specialized field?
The primary area of medical expertise for Mira Surjanto is Pharmacist, and the corresponding taxonomy classification code for this specialized field is 183500000X.
On what date did the Mira Surjanto receive the assignment of its 1124110705 from the Centers for Medicare & Medicaid Services?
The Mira Surjanto was issued its 1124110705 by the Centers for Medicare & Medicaid Services on 2006-09-29.
As of what date was the information regarding Mira Surjanto, such as address, specialty, and other details, last verified and confirmed to be up-to-date?
The information related to Mira Surjanto, including its address, specialty, and other relevant details, was last verified and confirmed to be up-to-date on 2007-07-08.
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