Provider Demographics
NPI:1598264848
Name:TAKATA, RONALYN MIRANDA NUESCA
Entity Type:Individual
Prefix:DR
First Name:RONALYN
Middle Name:MIRANDA NUESCA
Last Name:TAKATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46-047 KAMEHAMEHA HWY STE C
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3736
Mailing Address - Country:US
Mailing Address - Phone:808-235-4551
Mailing Address - Fax:
Practice Address - Street 1:46-047 KAMEHAMEHA HWY STE C
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3736
Practice Address - Country:US
Practice Address - Phone:808-235-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-3085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist