Provider Demographics
NPI:1548428410
Name:MIYASAKI, LOREN K (PHARM D)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:K
Last Name:MIYASAKI
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 HEALDSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3816
Mailing Address - Country:US
Mailing Address - Phone:707-431-1119
Mailing Address - Fax:707-431-0457
Practice Address - Street 1:525 HEALDSBURG AVE
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3816
Practice Address - Country:US
Practice Address - Phone:707-431-1119
Practice Address - Fax:707-431-0457
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist