Provider Demographics
NPI:1467928994
Name:KINOSHITA, RYAN TATSUO HAAHEO (PHARMD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:TATSUO HAAHEO
Last Name:KINOSHITA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 TORRANCE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3866
Mailing Address - Country:US
Mailing Address - Phone:808-343-4283
Mailing Address - Fax:
Practice Address - Street 1:3940 4TH AVE STE 150
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-7193
Practice Address - Country:US
Practice Address - Phone:619-574-9700
Practice Address - Fax:619-574-9701
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist