Provider Demographics
NPI:1437601689
Name:GUDOY, JERILYN (PHARM D)
Entity Type:Individual
Prefix:
First Name:JERILYN
Middle Name:
Last Name:GUDOY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E KAMEHAMEHA AVE
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2415
Mailing Address - Country:US
Mailing Address - Phone:808-872-3301
Mailing Address - Fax:
Practice Address - Street 1:10 E KAMEHAMEHA AVE
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2415
Practice Address - Country:US
Practice Address - Phone:808-872-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH4083183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist