Provider Demographics
NPI:1164614681
Name:CARTER, BRIAN A (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:A
Last Name:CARTER
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 1:6125 KOLOPUA ST
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746
Mailing Address - Country:US
Mailing Address - Phone:808-821-9418
Mailing Address - Fax:808-245-3866
Practice Address - Street 1:6125 KOLOPUA ST
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-9424
Practice Address - Country:US
Practice Address - Phone:808-821-9418
Practice Address - Fax:808-245-3866
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist