Provider Demographics
NPI:1396083622
Name:KOTA, ASHOK K (RPH)
Entity type:Individual
Prefix:
First Name:ASHOK
Middle Name:K
Last Name:KOTA
Suffix:
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 1:108 HEKILI ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2848
Mailing Address - Country:US
Mailing Address - Phone:808-293-9919
Mailing Address - Fax:
Practice Address - Street 1:108 HEKILI ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2848
Practice Address - Country:US
Practice Address - Phone:808-293-9919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2674183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI2674OtherSTATE ID