Provider Demographics
NPI:1134504632
Name:MIGUEL, RAYNOLD (RPH)
Entity Type:Individual
Prefix:
First Name:RAYNOLD
Middle Name:
Last Name:MIGUEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 KAPOLEI PKWY
Mailing Address - Street 2:TARGET #2411
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-1889
Mailing Address - Country:US
Mailing Address - Phone:808-457-3680
Mailing Address - Fax:
Practice Address - Street 1:4450 KAPOLEI PKWY
Practice Address - Street 2:TARGET #2411
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-1889
Practice Address - Country:US
Practice Address - Phone:808-457-3680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-25
Last Update Date:2015-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-1052183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist