Provider Demographics
NPI:1285934240
Name:SHIOTANI, BROOKE M (PHARM D)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:M
Last Name:SHIOTANI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3012
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-8012
Mailing Address - Country:US
Mailing Address - Phone:808-283-2503
Mailing Address - Fax:
Practice Address - Street 1:39 KAALEA WAY
Practice Address - Street 2:9D
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-3124
Practice Address - Country:US
Practice Address - Phone:808-283-2503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0010526183500000X
HIPH-2573183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist