Provider Demographics
NPI:1699505339
Name:MIYAGI, SHOGO JOHN (PHARMD PHD MS BCPPS)
Entity type:Individual
Prefix:DR
First Name:SHOGO
Middle Name:JOHN
Last Name:MIYAGI
Suffix:
Gender:M
Credentials:PHARMD PHD MS BCPPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 PUNAHOU ST BSMT
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1080
Mailing Address - Country:US
Mailing Address - Phone:808-983-8130
Mailing Address - Fax:
Practice Address - Street 1:1319 PUNAHOU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1080
Practice Address - Country:US
Practice Address - Phone:808-983-8130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-4417183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IND-915218OtherBOARD OF PHARMACY SPECIALTIES
HIPH-4417OtherSTATE OF HAWAII - BOARD OF PHARMACY