Provider Demographics
NPI:1629310255
Name:HAMAMOTO, KENJI (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENJI
Middle Name:
Last Name:HAMAMOTO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3165 26TH ST S
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-7654
Mailing Address - Country:US
Mailing Address - Phone:608-792-8169
Mailing Address - Fax:
Practice Address - Street 1:2840 21ST PL S
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-7302
Practice Address - Country:US
Practice Address - Phone:608-784-6500
Practice Address - Fax:608-784-6504
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1087940183500000X
MN120734183500000X
IL051.034750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist