Provider Demographics
NPI:1649584988
Name:IVERSON, LUCINDA KAMIKO (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LUCINDA
Middle Name:KAMIKO
Last Name:IVERSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44-181 LAHA ST APT 6
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2619
Mailing Address - Country:US
Mailing Address - Phone:808-351-5475
Mailing Address - Fax:
Practice Address - Street 1:44-181 LAHA ST APT 6
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2619
Practice Address - Country:US
Practice Address - Phone:808-351-5475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2024183500000X
CO15546183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist