Provider Demographics
NPI:1235788241
Name:MELCHOR, EMMANUEL SALVADOR
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:SALVADOR
Last Name:MELCHOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1738
Mailing Address - Street 2:
Mailing Address - City:KOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96756-1738
Mailing Address - Country:US
Mailing Address - Phone:808-639-3922
Mailing Address - Fax:
Practice Address - Street 1:4469 WAIALO ROAD
Practice Address - Street 2:
Practice Address - City:ELEELE
Practice Address - State:HI
Practice Address - Zip Code:96705
Practice Address - Country:US
Practice Address - Phone:808-335-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-2006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist