Healthcare Provider Details

I. General information

NPI: 1134483324
Provider Name (Legal Business Name): JAMES JOSEPH MIZNER JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11608 BRANDON HILL WAY
RESTON VA
20194-1215
US

IV. Provider business mailing address

11608 BRANDON HILL WAY
RESTON VA
20194-1215
US

V. Phone/Fax

Practice location:
  • Phone: 703-435-8163
  • Fax:
Mailing address:
  • Phone: 703-435-8163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202-006072
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: