Most Relevant Information
Provider Data
| NPI Number: | 1003584459 |
| Provider Name: | MIRACLE MERCEDES MARIE SMART |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/01/2021 |
| Last Updated: | 09/01/2021 |
Provider Practice Location
USC SCHOOL OF PHARMACY 1985 ZONAL AVE
LOS ANGELES
CA
900890001
Practice Location Phone/Fax
| Phone: | 3234421369 |
| Fax: |
Provider Mailing Location
2201 TROJAN WAY UNIT 4415
LOS ANGELES
CA
900332702
Provider Mailing Phone/Fax
| Phone: | 7604843091 |
| Fax: |