Individual
JOHN NIVISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
2091 NE 3RD ST, PRINEVILLE, OR 97754-8130
(541) 447-0395
Mailing address
20452 PINE VISTA DR, BEND, OR 97702-9437
(541) 420-5329
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5790
OR
Other
Enumeration date
07/22/2014
Last updated
07/22/2014
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