Provider Demographics
NPI:1518581263
Name:MIYASHIRO, BRADLEY KOICHI (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:KOICHI
Last Name:MIYASHIRO
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 1:1310 PENSACOLA ST APT 506
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1163
Mailing Address - Country:US
Mailing Address - Phone:808-258-9765
Mailing Address - Fax:
Practice Address - Street 1:500 N NIMITZ HWY
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5030
Practice Address - Country:US
Practice Address - Phone:808-528-3581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-3442183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist