Provider Demographics
NPI:1174166706
Name:OKAMURA, DEREK REN
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:REN
Last Name:OKAMURA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-934 KAMEHAMEHA HWY
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3243
Mailing Address - Country:US
Mailing Address - Phone:808-233-4601
Mailing Address - Fax:808-233-4627
Practice Address - Street 1:45-934 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3243
Practice Address - Country:US
Practice Address - Phone:808-233-4601
Practice Address - Fax:808-233-4627
Is Sole Proprietor?:No
Enumeration Date:2019-10-27
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-1612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist