Healthcare Provider Details

I. General information

NPI: 1487246096
Provider Name (Legal Business Name): JARIN MIYAMOTO PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 HEKILI ST
KAILUA HI
96734-2848
US

IV. Provider business mailing address

45-230 POPOKI PL
KANEOHE HI
96744-2351
US

V. Phone/Fax

Practice location:
  • Phone: 808-261-7329
  • Fax:
Mailing address:
  • Phone: 808-221-8979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH-4624
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: