Provider Demographics
NPI:1629653936
Name:TEIXEIRA, JEANNA (CPHT)
Entity Type:Individual
Prefix:
First Name:JEANNA
Middle Name:
Last Name:TEIXEIRA
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 1:1120 MAKAWAO AVE
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-9448
Mailing Address - Country:US
Mailing Address - Phone:808-573-9966
Mailing Address - Fax:808-573-8819
Practice Address - Street 1:1120 MAKAWAO AVE
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-9448
Practice Address - Country:US
Practice Address - Phone:808-573-9966
Practice Address - Fax:808-573-8819
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
30077972183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician