Provider Demographics
NPI:1497326144
Name:MISURA, REBECCA V
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:V
Last Name:MISURA
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 1:5178 BENSETT TRL
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-4803
Mailing Address - Country:US
Mailing Address - Phone:810-348-9117
Mailing Address - Fax:
Practice Address - Street 1:1020 E HILL RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-4803
Practice Address - Country:US
Practice Address - Phone:810-232-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-04
Last Update Date:2021-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303013879183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician