Provider Demographics
NPI:1154643070
Name:FUKUMOTO, STEVEN TOSHI (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:TOSHI
Last Name:FUKUMOTO
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 1:94-825 LUMIAINA ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-5025
Mailing Address - Country:US
Mailing Address - Phone:808-678-9701
Mailing Address - Fax:808-676-8616
Practice Address - Street 1:94-825 LUMIAINA ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-5025
Practice Address - Country:US
Practice Address - Phone:808-678-9701
Practice Address - Fax:808-676-8616
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI963183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist