Provider Demographics
NPI:1336720911
Name:CORRALES, NAOMI C (CPHT)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:C
Last Name:CORRALES
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78-6831 ALII DR STE 101
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2440
Mailing Address - Country:US
Mailing Address - Phone:808-322-2511
Mailing Address - Fax:808-322-1832
Practice Address - Street 1:78-6831 ALII DR STE 101
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2440
Practice Address - Country:US
Practice Address - Phone:808-322-2511
Practice Address - Fax:808-322-1832
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician