Healthcare Provider Details

I. General information

NPI: 1417402082
Provider Name (Legal Business Name): JAMIE MIZUSAWA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 08/20/2023
Certification Date: 08/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 PALI HWY
HONOLULU HI
96813-2230
US

IV. Provider business mailing address

1330 PALI HWY
HONOLULU HI
96813-2282
US

V. Phone/Fax

Practice location:
  • Phone: 808-536-5542
  • Fax:
Mailing address:
  • Phone: 808-536-5542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60648463
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: