Provider Demographics
NPI:1689091472
Name:WATARAI, HIROKI (PHARMD, MPA)
Entity Type:Individual
Prefix:
First Name:HIROKI
Middle Name:
Last Name:WATARAI
Suffix:
Gender:M
Credentials:PHARMD, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 WOODLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-3029
Mailing Address - Country:US
Mailing Address - Phone:305-809-6780
Mailing Address - Fax:
Practice Address - Street 1:83 WOODLAND PARK DR
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-3029
Practice Address - Country:US
Practice Address - Phone:305-809-6780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42552183500000X
NJ28RI03153100183500000X
GUPH0184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist