Provider Demographics
NPI:1780073411
Name:MOTOKUBOTA, HIROKI (PHARMD)
Entity type:Individual
Prefix:
First Name:HIROKI
Middle Name:
Last Name:MOTOKUBOTA
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 1:10 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2445
Mailing Address - Country:US
Mailing Address - Phone:620-624-5334
Mailing Address - Fax:620-624-5096
Practice Address - Street 1:10 W 15TH ST
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2445
Practice Address - Country:US
Practice Address - Phone:620-624-5334
Practice Address - Fax:620-624-5096
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-16816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist