Provider Demographics
NPI:1083755441
Name:KAISER FOUNDATION HOSPITALS
Entity Type:Organization
Organization Name:KAISER FOUNDATION HOSPITALS
Other - Org Name:KAISER FOUNDATION HOSPITAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:MIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKAHASHI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:808-432-8114
Mailing Address - Street 1:3288 MOANALUA RD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1495
Mailing Address - Country:US
Mailing Address - Phone:808-432-8100
Mailing Address - Fax:808-432-8791
Practice Address - Street 1:3288 MOANALUA RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1469
Practice Address - Country:US
Practice Address - Phone:808-432-8100
Practice Address - Fax:808-432-8791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
HIPHY-3553336M0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI54328201Medicaid
2018331OtherPK