Provider Demographics
NPI:1104978758
Name:WAKAYAMA, SUSAN C (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:C
Last Name:WAKAYAMA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2499 KAPIOLANI BLVD
Mailing Address - Street 2:APT 1209
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-5310
Mailing Address - Country:US
Mailing Address - Phone:808-946-2353
Mailing Address - Fax:
Practice Address - Street 1:501 ALAKAWA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5700
Practice Address - Country:US
Practice Address - Phone:808-432-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist