Provider Demographics
NPI:1497801773
Name:BASINGA, PEGGY J (CPHT)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:J
Last Name:BASINGA
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:CAPTAIN COOK
Mailing Address - State:HI
Mailing Address - Zip Code:96704-0206
Mailing Address - Country:US
Mailing Address - Phone:808-929-9296
Mailing Address - Fax:
Practice Address - Street 1:78-6831 ALII DR
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2495
Practice Address - Country:US
Practice Address - Phone:808-929-9296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI130109478952938183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician