Provider Demographics
NPI:1437459914
Name:IJAMS, JEFFERY KEITH
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:KEITH
Last Name:IJAMS
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 1:75-1027 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-3154
Mailing Address - Country:US
Mailing Address - Phone:808-327-6778
Mailing Address - Fax:808-327-6782
Practice Address - Street 1:75-1027 HENRY ST
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3154
Practice Address - Country:US
Practice Address - Phone:808-327-6778
Practice Address - Fax:808-327-6782
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-2915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist