Provider Demographics
NPI:1003464371
Name:FERNANDEZ, JACKWAYNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACKWAYNE
Middle Name:
Last Name:FERNANDEZ
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 1:1330 PALI HWY
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2230
Mailing Address - Country:US
Mailing Address - Phone:808-536-5542
Mailing Address - Fax:808-536-0659
Practice Address - Street 1:1330 PALI HWY
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2230
Practice Address - Country:US
Practice Address - Phone:808-536-5542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-3523183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist