DR. Mira Surjanto, PHARM.D.

NPI #1124110705 in Vallejo, California

Provider Information

NPI Number: 1124110705
Entity Type: Individual
Name: DR. Mira Surjanto, PHARM.D.
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Pharmacist
Credential: PHARM.D.
Enumeration Date: Sep 29, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 975 SERENO DR
Address 2: MOB MEDICINE 7
City: Vallejo
State: California
ZIP Code: 94589-2441
Phone: (707) 651-2584

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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