Provider Demographics
NPI:1124394838
Name:IKEDA, LORI A (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:A
Last Name:IKEDA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 KEAHOLE ST BLDG A
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-3428
Mailing Address - Country:US
Mailing Address - Phone:808-394-3318
Mailing Address - Fax:808-394-3327
Practice Address - Street 1:333 KEAHOLE ST BLDG A
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-3428
Practice Address - Country:US
Practice Address - Phone:808-394-3318
Practice Address - Fax:808-394-3327
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-1825183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist