Provider Demographics
NPI:1356492508
Name:LUNA, DANE
Entity Type:Individual
Prefix:
First Name:DANE
Middle Name:
Last Name:LUNA
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 1:1279 S KIHEI RD
Mailing Address - Street 2:SUITE #120
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-5222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1279 S KIHEI RD
Practice Address - Street 2:SUITE #120
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-5222
Practice Address - Country:US
Practice Address - Phone:808-891-6860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist