Provider Demographics
NPI:1326315839
Name:MABUTI, JOHNMAR FLORUNGCO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHNMAR
Middle Name:FLORUNGCO
Last Name:MABUTI
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 1:301 E MAKAALA ST
Mailing Address - Street 2:WALGREENS PHARMACY
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5146
Mailing Address - Country:US
Mailing Address - Phone:808-561-8268
Mailing Address - Fax:
Practice Address - Street 1:301 E MAKAALA ST
Practice Address - Street 2:WALGREENS PHARMACY
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5146
Practice Address - Country:US
Practice Address - Phone:808-561-8268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3198183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist