Provider Demographics
NPI:1649262619
Name:NAKATSU, MILES T (RPH, CDE, CDM)
Entity type:Individual
Prefix:MR
First Name:MILES
Middle Name:T
Last Name:NAKATSU
Suffix:
Gender:M
Credentials:RPH, CDE, CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 ULULANI ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3913
Mailing Address - Country:US
Mailing Address - Phone:808-934-9400
Mailing Address - Fax:
Practice Address - Street 1:868 ULULANI ST
Practice Address - Street 2:SUITE 107
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3913
Practice Address - Country:US
Practice Address - Phone:808-934-9400
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH 822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist