Provider Demographics
NPI:1326520784
Name:HIURA, JON MICHIO
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:MICHIO
Last Name:HIURA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-5222
Mailing Address - Country:US
Mailing Address - Phone:925-439-7422
Mailing Address - Fax:925-439-2141
Practice Address - Street 1:230 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5222
Practice Address - Country:US
Practice Address - Phone:925-439-7422
Practice Address - Fax:925-439-2141
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-02
Last Update Date:2018-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI05-0340626Medicaid