Provider Demographics
NPI:1669357125
Name:ZOA, MIREILLE HENRIETTE LINE (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MIREILLE
Middle Name:HENRIETTE LINE
Last Name:ZOA
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 JUSTIN RD
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-3071
Mailing Address - Country:US
Mailing Address - Phone:972-966-0526
Mailing Address - Fax:972-966-2114
Practice Address - Street 1:2360 JUSTIN RD
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-3071
Practice Address - Country:US
Practice Address - Phone:972-966-0526
Practice Address - Fax:972-966-2114
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist