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DR. MIRA SURJANTO PHARM.D.
NPI 1124110705
Pharmacist in Vallejo, CA

Active since September 29, 2006
975 SERENO DR, MOB MEDICINE 7, VALLEJO, CA 94589(707) 651-2584 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Mira Surjanto Pharm.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. MIRA SURJANTO PHARM.D. (NPI 1124110705) is an individual pharmacist in Vallejo, California, licensed in California (51280) and active in the NPI registry since September 2006.

NPPES Registry Identity

NPI1124110705
Entity TypeIndividualFemale
Primary Taxonomy183500000X
Provider Legal NameDR. MIRA SURJANTOCredential: PHARM.D.
Location Address975 SERENO DR, MOB MEDICINE 7Vallejo, CA 94589-2441
Mailing Address975 Sereno Dr, Mob Medicine 7Vallejo, CA 94589-2441
Phone(707) 651-2584
Sole ProprietorNo
Enumeration DateSeptember 29, 2006
Last NPPES UpdateJuly 8, 2007
✔ NPI 1124110705 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPharmacistPharmacy Service Providers
Taxonomy Code183500000X
License✔ Licensed in CA · 51280
Definition
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, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care.
975 SERENO DR, Vallejo, CA 94589
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ROBERTA YIWUN WANG M.D.
Physical Medicine & Rehabilitation
975 SERENO DR
VALLEJO, CA 94589
Napa County (707) 651-5128
RIHONG ZHOU
Pharmacist
975 SERENO DR
VALLEJO, CA 94589
Napa County (707) 651-2072
EVAN HIRSCHBEIN
Student in an Organized Health Care Education/Training Program
975 SERENO DR
VALLEJO, CA 94589
Napa County (707) 339-2074
MS. JEAN BROADNAX LCSW
Social Worker (Clinical)
975 SERENO DR
VALLEJO, CA 94589
Napa County (707) 651-4423
SEAN NISAM
Student in an Organized Health Care Education/Training Program
975 SERENO DR
VALLEJO, CA 94589
Napa County (707) 651-4071
LI M. TSANG MD
Anesthesiology
975 SERENO DR
VALLEJO, CA 94589
Napa County (707) 651-1000
DONN R. ERICKSON MD
Family Medicine
975 SERENO DR
VALLEJO, CA 94589
Napa County (707) 651-1000
JOHN S. WOOD MD
Surgery
975 SERENO DR
VALLEJO, CA 94589
Napa County (707) 651-1000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mira Surjanto's NPI number?

The NPI number for Mira Surjanto is 1124110705. It was assigned to this individual provider in the NPPES registry on September 29, 2006.

Where is Mira Surjanto located?

Mira Surjanto practices at 975 Sereno Dr Mob Medicine 7, Vallejo, CA 94589. The listed phone number is (707) 651-2584.

What is Mira Surjanto's specialty?

The primary specialty registered for this NPI is Pharmacist with taxonomy code 183500000X.

When was this NPI record last updated?

The NPPES record for Mira Surjanto was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.