Provider Demographics
NPI:1568598126
Name:OWENS, JOHNNIE MACK (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:MACK
Last Name:OWENS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 MANU IHU PL
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7701
Mailing Address - Country:US
Mailing Address - Phone:808-874-0702
Mailing Address - Fax:808-874-0702
Practice Address - Street 1:1310 S KIHEI RD
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8135
Practice Address - Country:US
Practice Address - Phone:808-875-4695
Practice Address - Fax:808-879-7480
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH1395183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist