Provider Demographics
NPI:1104866854
Name:UNIVERSITY OF HAWAII AT MANOA
Entity Type:Organization
Organization Name:UNIVERSITY OF HAWAII AT MANOA
Other - Org Name:UNIVERSITY OF HAWAII STUDENT HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-956-8965
Mailing Address - Street 1:1710 E WEST RD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-2317
Mailing Address - Country:US
Mailing Address - Phone:808-956-8965
Mailing Address - Fax:808-956-3583
Practice Address - Street 1:1710 E WEST RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-2317
Practice Address - Country:US
Practice Address - Phone:808-956-8965
Practice Address - Fax:808-956-3583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
HIPHY-4983336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2018860OtherPK