Provider Demographics
NPI:1992373864
Name:MIYAMA, KELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELLE
Middle Name:
Last Name:MIYAMA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5685 INLAND SHORES WAY N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-3794
Mailing Address - Country:US
Mailing Address - Phone:503-779-2271
Mailing Address - Fax:
Practice Address - Street 1:5685 INLAND SHORES WAY N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-3794
Practice Address - Country:US
Practice Address - Phone:503-779-2271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0018028183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist