=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508917626
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT SCOTT CORSON RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 MAUILANI PKWY
-----------------------------------------------------
City | WAILUKU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96793-2416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-243-6565
-----------------------------------------------------
Fax | 808-243-6568
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 415 DAIRY RD STE E-143
-----------------------------------------------------
City | KAHULUI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96732-2312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-264-0172
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PH-1135
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------