Provider Demographics
NPI:1336435700
Name:MIYAKE-NOGAWA, KERRI T (PHARMD)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:T
Last Name:MIYAKE-NOGAWA
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 1:4450 KAPOLEI PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-1878
Mailing Address - Country:US
Mailing Address - Phone:808-457-3680
Mailing Address - Fax:
Practice Address - Street 1:4450 KAPOLEI PKWY STE 100
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-1878
Practice Address - Country:US
Practice Address - Phone:808-457-3680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-2215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist