Healthcare Provider Details

I. General information

NPI: 1871803007
Provider Name (Legal Business Name): CAITLIN MIYUKI KANOELANI MIZOSHIRI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-1146 MOOLELO ST
WAIPAHU HI
96797-4127
US

IV. Provider business mailing address

94-1146 MOOLELO ST
WAIPAHU HI
96797-4127
US

V. Phone/Fax

Practice location:
  • Phone: 808-721-2304
  • Fax:
Mailing address:
  • Phone: 808-721-2304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number68974
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3578
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: