Healthcare Provider Details

I. General information

NPI: 1043841034
Provider Name (Legal Business Name): LORI IWAMASA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-1249 MEHEULA PKWY STE D
MILILANI HI
96789-1779
US

IV. Provider business mailing address

95-1249 MEHEULA PKWY STE D
MILILANI HI
96789-1779
US

V. Phone/Fax

Practice location:
  • Phone: 808-625-5222
  • Fax:
Mailing address:
  • Phone: 808-625-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH-2699
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: