1427383900 NPI number — DR. TAQUINA MIRANDA WARREN PHARMD

Table of content: DR. TAQUINA MIRANDA WARREN PHARMD (NPI 1427383900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427383900 NPI number — DR. TAQUINA MIRANDA WARREN PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARREN
Provider First Name:
TAQUINA
Provider Middle Name:
MIRANDA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILSON
Provider Other First Name:
TAQUINA
Provider Other Middle Name:
MIRANDA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427383900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 BERRYMAN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19709-1649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-376-0437
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 E GLENWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMYRNA
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19977-1424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-471-3046
Provider Business Practice Location Address Fax Number:
302-508-2275
Provider Enumeration Date:
10/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: A1-0003519 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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