Provider Demographics
NPI:1821762006
Name:OTAKE, REGINA KAWAIOLA AH MUI CHOW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:KAWAIOLA AH MUI CHOW
Last Name:OTAKE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1434 KAIKOHOLA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6261
Mailing Address - Country:US
Mailing Address - Phone:808-227-3858
Mailing Address - Fax:
Practice Address - Street 1:91-1010 SHANGRILA ST STE 500
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2175
Practice Address - Country:US
Practice Address - Phone:808-433-5423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-2935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist