Individual provider Active NPI

Kenji Hamamoto, RPH

  • Pharmacist
  • La Crosse, WI
National Provider Identifier
1629310255
Registry record updated Jan 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
1087940 Issued in WI
Practice address
2840 21St PL S
La Crosse, WI 54601-7302
Phone
(608) 784-6500
Fax
(608) 784-6504
NPI assigned
Mar 21, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 1087940 WI Primary
Pharmacist 183500000X 120734 MN
Pharmacist 183500000X 051.034750 IL

Addresses

Primary practice location

2840 21St PL S
La Crosse, WI 54601-7302

Mailing address

3165 26TH St S
La Crosse, WI 54601-7654
Phone (608) 792-8169

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
051.034750ILMDPharmacist
120734MNMDPharmacist
1087940WIMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1363824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452211200000",
    "number": "1629310255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3165 26TH ST S",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546017654",
            "telephone_number": "608-792-8169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2840 21ST PL S",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546017302",
            "telephone_number": "608-784-6500",
            "fax_number": "608-784-6504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAMAMOTO",
        "first_name": "KENJI",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-21",
        "last_updated": "2016-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "1087940",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "120734",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051.034750",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Crosse, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.