Provider Demographics
NPI:1528546413
Name:MIYAZAKI, NECOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:NECOLE
Middle Name:
Last Name:MIYAZAKI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1546 KIKAHA ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3242
Mailing Address - Country:US
Mailing Address - Phone:808-228-4685
Mailing Address - Fax:
Practice Address - Street 1:78-6831 ALII DR STE 101
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2440
Practice Address - Country:US
Practice Address - Phone:808-322-2511
Practice Address - Fax:808-322-1832
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-4015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist