Active NPI
Miranda Diane Boisclair, PHARMD
- Geriatric Pharmacist
- Los Angeles, CA
National Provider Identifier
1619053154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Pharmacist
- License
- 011439
- Practice address
- 11301 Wilshire Blvd BLDG 500
Los Angeles, CA 90073-1003 - Phone
- (310) 362-0179
- NPI assigned
- Oct 27, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Pharmacist | 1835G0303X | 011439 | SC | Primary |
Addresses
Primary practice location
11301 Wilshire Blvd BLDG 500
Los Angeles, CA 90073-1003
Mailing address
535 Gayley Ave Apt 207
Los Angeles, CA 90024-2040
Phone (843) 597-0429
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011439 | SC | MD | Geriatric Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1619053154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "535 GAYLEY AVE APT 207",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900242040",
"telephone_number": "843-597-0429"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11301 WILSHIRE BLVD BLDG 500",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900731003",
"telephone_number": "310-362-0179"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOISCLAIR",
"first_name": "MIRANDA",
"middle_name": "DIANE",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1835G0303X",
"taxonomy_group": "",
"desc": "Pharmacist, Geriatric",
"state": "SC",
"license": "011439",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.