Healthcare Provider Details

I. General information

NPI: 1780955948
Provider Name (Legal Business Name): JOHN D MIURA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 E 2ND AVE STE 6
SPOKANE WA
99202-2207
US

IV. Provider business mailing address

1011 E 2ND AVE STE 6
SPOKANE WA
99202-2207
US

V. Phone/Fax

Practice location:
  • Phone: 509-744-9891
  • Fax: 509-742-3494
Mailing address:
  • Phone: 509-744-9891
  • Fax: 509-742-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60219227
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: