Provider Demographics
NPI:1942580584
Name:MIYAKE, PATRICIA (PHD, RPH)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:MIYAKE
Suffix:
Gender:F
Credentials:PHD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:WAUCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:60084-3405
Mailing Address - Country:US
Mailing Address - Phone:847-487-9383
Mailing Address - Fax:847-487-9626
Practice Address - Street 1:602 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084-3405
Practice Address - Country:US
Practice Address - Phone:847-487-9383
Practice Address - Fax:847-487-9626
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051288878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist