Provider Demographics
NPI:1609414713
Name:KAWAMOTO, MISA
Entity Type:Individual
Prefix:
First Name:MISA
Middle Name:
Last Name:KAWAMOTO
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 1:20056 BETZ DR
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-1107
Mailing Address - Country:US
Mailing Address - Phone:808-741-1329
Mailing Address - Fax:
Practice Address - Street 1:20056 BETZ DR
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-1107
Practice Address - Country:US
Practice Address - Phone:808-741-1329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist