Mira Surjanto, PHARM.D

NPI: 1124110705

Mira Surjanto, PHARM.D

Q: What is Mira Surjanto's NPI number?

Mira Surjanto's NPI number is 1124110705, a unique 10-digit identifier issued by CMS.

Q: What does Mira Surjanto specialize in?

Mira Surjanto specializes in Pharmacist, taxonomy code 183500000X.

Q: Where does Mira Surjanto practice?

Mira Surjanto practices in Vallejo, CA 94589-2441.

Q: When was Mira Surjanto's NPI issued?

Mira Surjanto's NPI was issued on September 29, 2006.

Q: What is Mira Surjanto's provider type?

Mira Surjanto is an Individual Provider under CMS NPI Type 1.

ActiveIndividual ProviderPharmacist

NPI issued: September 29, 2006

Quick Facts

NPI Number

1124110705

TypeIndividual

StatusActive

SpecialtyPharmacist

Taxonomy183500000X — Pharmacist

Phone

(707) 651-2584

StateCA

NPI Validation Status: Verified

✅Valid 10-digit NPI number (1124110705)

✅Active status confirmed

✅Verified by CMS NPPES Registry

✅HIPAA compliant identifier

✅Enumeration date on file (September 29, 2006)

Data source: CMS NPPES

Provider Overview

MIRA SURJANTO, PHARM.D is a Pharmacist provider based in Vallejo, CA who has been registered with CMS since 2006. This NPI is currently Active under CMS NPPES registry.

Provider Details

NPI Number1124110705

Provider TypeIndividual Provider

GenderFemale

CredentialPHARM.D

StatusActive

Enumeration DateSeptember 29, 2006

Practice Location

CityVallejo

StateCA

ZIP Code94589-2441

Phone(707) 651-2584

Specialties & Licenses

★ Primary

SpecialtyPharmacist

Taxonomy Code183500000X

License StateCA

Mailing Address

CityVallejo

StateCA

ZIP Code94589-2441

Phone(707) 651-2584

Same as practice location

How to Use This NPI

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For Insurance Billing

Use NPI 1124110705 in Box 33 of the CMS-1500 claim form. This number is required by all major insurance carriers to identify the billing provider and process electronic medical claims.

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For Credentialing

Reference NPI 1124110705for provider credential verification. Hospital systems, state licensing boards, and CAQH directories query this number to verify the provider's active clinical status.

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For Patients

Share NPI 1124110705 with your insurance company. If you need to verify out-of-network benefits or file a reimbursement claim, your insurance provider will require this number to process it.

About Pharmacist

Pharmacists are healthcare professionals who specialize in the correct preparation, dispensing, and clinical management of medications, ensuring safe and effective prescription use for patients.

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