Provider Demographics
NPI:1972590131
Name:KIMURA, VIVIAN K (RPH)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:K
Last Name:KIMURA
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 1:59 HOOMAHA ST
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-2544
Mailing Address - Country:US
Mailing Address - Phone:808-473-1880
Mailing Address - Fax:808-473-0479
Practice Address - Street 1:480 CENTER AVE
Practice Address - Street 2:
Practice Address - City:PEARL HARBOR
Practice Address - State:HI
Practice Address - Zip Code:96801
Practice Address - Country:US
Practice Address - Phone:808-473-1880
Practice Address - Fax:808-473-0479
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist