Provider Demographics
NPI:1164910915
Name:MIURA, YURI
Entity Type:Individual
Prefix:DR
First Name:YURI
Middle Name:
Last Name:MIURA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 KALAKAUA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-2354
Mailing Address - Country:US
Mailing Address - Phone:808-922-8790
Mailing Address - Fax:
Practice Address - Street 1:2155 KALAKAUA AVE STE 102
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-2354
Practice Address - Country:US
Practice Address - Phone:808-922-8790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist