Provider Demographics
NPI:1386983153
Name:MIGUEL, TILDEN-CHRISTEN MICHAEL (RPH, PHARMD)
Entity type:Individual
Prefix:DR
First Name:TILDEN-CHRISTEN
Middle Name:MICHAEL
Last Name:MIGUEL
Suffix:
Gender:M
Credentials:RPH, PHARMD
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 262
Mailing Address - Street 2:
Mailing Address - City:VOLCANO
Mailing Address - State:HI
Mailing Address - Zip Code:96785-0262
Mailing Address - Country:US
Mailing Address - Phone:808-221-9780
Mailing Address - Fax:
Practice Address - Street 1:111 E PUAINAKO ST.
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720
Practice Address - Country:US
Practice Address - Phone:808-959-4508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2022-09-16
Deactivation Date:2018-01-09
Deactivation Code:
Reactivation Date:2022-09-15
Provider Licenses
StateLicense IDTaxonomies
HIPH-3429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist