Healthcare Provider Details

I. General information

NPI: 1508917626
Provider Name (Legal Business Name): ROBERT SCOTT CORSON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MAUILANI PKWY
WAILUKU HI
96793-2416
US

IV. Provider business mailing address

415 DAIRY RD STE E-143
KAHULUI HI
96732-2312
US

V. Phone/Fax

Practice location:
  • Phone: 808-243-6565
  • Fax: 808-243-6568
Mailing address:
  • Phone: 808-264-0172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH-1135
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: