Healthcare Provider Details

I. General information

NPI: 1285539338
Provider Name (Legal Business Name): EMILY MAIDAWB MOUA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12509 E MISSION AVE STE 103
SPOKANE VALLEY WA
99216-1061
US

IV. Provider business mailing address

1320 S GLENN RD
SPOKANE VALLEY WA
99206-5645
US

V. Phone/Fax

Practice location:
  • Phone: 509-928-6400
  • Fax:
Mailing address:
  • Phone: 509-822-9513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHRM.PH.70153610
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: