Provider Demographics
NPI:1558414557
Name:VITA, ELEADON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELEADON
Middle Name:
Last Name:VITA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:MR
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:VITA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3161 PAPALA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1277
Mailing Address - Country:US
Mailing Address - Phone:808-988-3818
Mailing Address - Fax:
Practice Address - Street 1:525 ALAKAWA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5764
Practice Address - Country:US
Practice Address - Phone:808-526-6102
Practice Address - Fax:808-526-6121
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-1695183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH-47924OtherPHARMACIST
HIPH-1695OtherPHARMACIST