Provider Demographics
NPI:1598016735
Name:HIGUCHI, KYLE TADAMI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:TADAMI
Last Name:HIGUCHI
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 1:1194 PUHAU ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3488
Mailing Address - Country:US
Mailing Address - Phone:808-640-4076
Mailing Address - Fax:
Practice Address - Street 1:75-1027 HENRY ST
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3154
Practice Address - Country:US
Practice Address - Phone:808-327-6778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-3408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist