Provider Demographics
NPI:1073198446
Name:TAKUSHI, MARI (PHARMD/RPH)
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:
Last Name:TAKUSHI
Suffix:
Gender:F
Credentials:PHARMD/RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-1507 AINAMAKUA DR
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-4406
Mailing Address - Country:US
Mailing Address - Phone:808-542-8207
Mailing Address - Fax:
Practice Address - Street 1:95-1507 AINAMAKUA DR
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-4406
Practice Address - Country:US
Practice Address - Phone:808-542-8207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP454045183500000X
HIPH-4381183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist