Provider Demographics
NPI:1558545681
Name:CUSTOMIZED THERAPEUTICS LLC
Entity Type:Organization
Organization Name:CUSTOMIZED THERAPEUTICS LLC
Other - Org Name:BIG ISLAND HEMATOLOGY-ONCOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLUWOLE
Authorized Official - Middle Name:O
Authorized Official - Last Name:ODUJINRIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-557-0864
Mailing Address - Street 1:3465 WAIALAE AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-2650
Mailing Address - Country:US
Mailing Address - Phone:808-432-9216
Mailing Address - Fax:808-533-1482
Practice Address - Street 1:75-5995 KUAKINI HWY STE 427
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2123
Practice Address - Country:US
Practice Address - Phone:808-557-0864
Practice Address - Fax:808-329-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23749207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI=========OtherTAX ID