Provider Demographics
NPI:1033604210
Name:CHOMIUK, JEFFREY (RPH)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:CHOMIUK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5904 WAIPOULI RD
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-8822
Mailing Address - Country:US
Mailing Address - Phone:808-635-5524
Mailing Address - Fax:808-245-3866
Practice Address - Street 1:3-3420B KUHIO HWY STE 101
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1096
Practice Address - Country:US
Practice Address - Phone:808-635-5524
Practice Address - Fax:808-245-3866
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH3138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIPH3138OtherPHARMCIST LICENSE HAWAII STATE BOARD OF PHARMACY