Provider Demographics
NPI:1891095998
Name:NAGAHAMA, KANANI
Entity Type:Individual
Prefix:DR
First Name:KANANI
Middle Name:
Last Name:NAGAHAMA
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 1:111 E PUAINAKO ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5288
Mailing Address - Country:US
Mailing Address - Phone:808-959-2000
Mailing Address - Fax:808-959-2026
Practice Address - Street 1:111 E PUAINAKO ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5288
Practice Address - Country:US
Practice Address - Phone:808-959-2000
Practice Address - Fax:808-959-2026
Is Sole Proprietor?:No
Enumeration Date:2010-10-24
Last Update Date:2010-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2438183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist