Provider Demographics
NPI:1003968298
Name:TAKARA, ROSS T (PHARMD)
Entity type:Individual
Prefix:MR
First Name:ROSS
Middle Name:T
Last Name:TAKARA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1968 ALA MAHAMOE PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1601
Mailing Address - Country:US
Mailing Address - Phone:808-839-9872
Mailing Address - Fax:
Practice Address - Street 1:2828 PAA ST STE 2420B
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4405
Practice Address - Country:US
Practice Address - Phone:808-432-5787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH24581835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy