Provider Demographics
NPI:1063013563
Name:HIROKAWA, TYLER KEN
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:KEN
Last Name:HIROKAWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 BULL RUN DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-4768
Mailing Address - Country:US
Mailing Address - Phone:808-756-1549
Mailing Address - Fax:
Practice Address - Street 1:1400 LOWES BLVD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-5201
Practice Address - Country:US
Practice Address - Phone:254-526-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist