Provider Demographics
NPI:1932608221
Name:NISHIKAWA, RYAN WADE IKAIKA (PHARMD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:WADE IKAIKA
Last Name:NISHIKAWA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46-047 KAMEHAMEHA HWY STE C
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3736
Mailing Address - Country:US
Mailing Address - Phone:808-235-4551
Mailing Address - Fax:808-236-4626
Practice Address - Street 1:46-047 KAMEHAMEHA HWY STE C
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3736
Practice Address - Country:US
Practice Address - Phone:808-235-4551
Practice Address - Fax:808-235-4551
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-3536183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty