Provider Demographics
NPI:1588018493
Name:PIVO, CRAIG (PHARMD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:PIVO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-6226 PIENA PL
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-7948
Mailing Address - Country:US
Mailing Address - Phone:808-895-4094
Mailing Address - Fax:
Practice Address - Street 1:75-6226 PIENA PL
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-7948
Practice Address - Country:US
Practice Address - Phone:808-895-4094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-17
Last Update Date:2016-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH3949183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist