Provider Demographics
NPI:1134141567
Name:MIYAHARA, RANDELL KAZUTO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RANDELL
Middle Name:KAZUTO
Last Name:MIYAHARA
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 1:1666 ANDALUSIA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5801
Mailing Address - Country:US
Mailing Address - Phone:408-723-0799
Mailing Address - Fax:
Practice Address - Street 1:3801 MIRANDA AVE # 119
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH015228183500000X
CARPH39775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist