Individual provider · Type 1 NPI

Mira Surjanto, PharmD

Pharmacist · Vallejo, CA

NPI number 1124110705 Active

Practice location

975 Sereno Dr, Mob Medicine 7
Vallejo, CA 94589-2441

Call (707) 651-2584 Map

Specialties and licenses

TaxonomyCodeLicense
Pharmacist Primary 183500000X51280 (CA)

Pharmacist: 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 modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage…

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About NPI 1124110705

Mira Surjanto, PharmD's National Provider Identifier is 1124110705, issued on Sep 29, 2006. The primary taxonomy on file is Pharmacist (183500000X), and the practice location is in Vallejo, CA. The record was last updated on Jul 8, 2007.