Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Justin Tyler Miracle

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1497354880

Mr. Justin Tyler Miracle is a Student in an Organized Health Care Education/Training Program in Corvallis, Oregon. Works from 2 locations. Licensed in Oregon.

Licensed in
OR
In the registry since
2020
Specialties on file
2
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Practice location Address checks out

777 NW Kings Blvd
Corvallis, OR 97330-5620
Phone: (541) 754-5583
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3545 Ne Canterbury Cir, Corvallis, OR 97330-4007 — (503) 877-4430

Specialties & licences

Pharmacist (primary) Taxonomy 183500000X · Licence RPH0018483 (OR)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X · Licence PI-0013024 (OR)

Record details

NPI number1497354880
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedOctober 18, 2020
Last updated in NPPESNovember 15, 2023
Certification dateNovember 15, 2023

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