Healthcare Provider Details

I. General information

NPI: 1376450080
Provider Name (Legal Business Name): BERT MATSUO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S BERETANIA ST STE 610
HONOLULU HI
96813-2496
US

IV. Provider business mailing address

1456 THURSTON AVE APT 1404
HONOLULU HI
96822-3639
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-8900
  • Fax: 808-691-8919
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPH-4324
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: