Provider Demographics
NPI:1255950903
Name:KUMASAKA, JARED YOSHIAKI SR (RPH)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:YOSHIAKI
Last Name:KUMASAKA
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-871 MAKAUNULAU ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2834
Mailing Address - Country:US
Mailing Address - Phone:808-623-1106
Mailing Address - Fax:
Practice Address - Street 1:89-102 FARRINGTON HWY
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-4101
Practice Address - Country:US
Practice Address - Phone:808-913-6145
Practice Address - Fax:808-464-9826
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist