Provider Demographics
NPI:1417450164
Name:LUM, SARA MITSUE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MITSUE
Last Name:LUM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5156 KALANIANAOLE HWY
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-1507
Mailing Address - Country:US
Mailing Address - Phone:808-377-9643
Mailing Address - Fax:
Practice Address - Street 1:5156 KALANIANAOLE HWY
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-1507
Practice Address - Country:US
Practice Address - Phone:808-377-9643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-3735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist