Healthcare Provider Details

I. General information

NPI: 1063565232
Provider Name (Legal Business Name): CAROLINE RITSUKO MIZO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-1480 MOANIANI ST
WAIPAHU HI
96797-4632
US

IV. Provider business mailing address

95-200 ANUANU PL
MILILANI HI
96789-5576
US

V. Phone/Fax

Practice location:
  • Phone: 808-432-3150
  • Fax:
Mailing address:
  • Phone: 808-226-0715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2063
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: