Provider Demographics
NPI:1588213961
Name:TOMINAGA, GALEN
Entity Type:Individual
Prefix:MR
First Name:GALEN
Middle Name:
Last Name:TOMINAGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3-2600 KAUMUALII HWY STE 1100
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1697
Mailing Address - Country:US
Mailing Address - Phone:808-245-8871
Mailing Address - Fax:
Practice Address - Street 1:3-2600 KAUMUALII HWY STE 1100
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1697
Practice Address - Country:US
Practice Address - Phone:808-245-8871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-2315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist