Provider Demographics
NPI:1609518695
Name:IMAI, MATTHEW TAKEO (PHARMD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TAKEO
Last Name:IMAI
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 1:4303 NAWILIWILI RD
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-9581
Mailing Address - Country:US
Mailing Address - Phone:808-431-6039
Mailing Address - Fax:808-650-2935
Practice Address - Street 1:4303 NAWILIWILI RD
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-9581
Practice Address - Country:US
Practice Address - Phone:808-431-6039
Practice Address - Fax:808-650-2935
Is Sole Proprietor?:No
Enumeration Date:2022-04-10
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist