Provider Demographics
NPI:1881284388
Name:BUTED, CLARISSA CARLOS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CLARISSA
Middle Name:CARLOS
Last Name:BUTED
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 1:1616 MALIU ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-3622
Mailing Address - Country:US
Mailing Address - Phone:808-777-8330
Mailing Address - Fax:
Practice Address - Street 1:95-1077 AINAMAKUA DR
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-4252
Practice Address - Country:US
Practice Address - Phone:808-626-2380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-4622183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist