Provider Demographics
NPI:1780955948
Name:MIURA, JOHN D (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:MIURA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 E 2ND AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2207
Mailing Address - Country:US
Mailing Address - Phone:509-744-9891
Mailing Address - Fax:509-742-3494
Practice Address - Street 1:1011 E 2ND AVE STE 6
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2207
Practice Address - Country:US
Practice Address - Phone:509-744-9891
Practice Address - Fax:509-742-3494
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60219227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist