Provider Demographics
NPI:1740407840
Name:KAISER FOUNDATION HOSPITALS
Entity Type:Organization
Organization Name:KAISER FOUNDATION HOSPITALS
Other - Org Name:KAISER HILO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:808-934-4090
Mailing Address - Street 1:1292 WAIANUENUE AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-1228
Mailing Address - Country:US
Mailing Address - Phone:808-934-4090
Mailing Address - Fax:808-934-4089
Practice Address - Street 1:1292 WAIANUENUE AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-1228
Practice Address - Country:US
Practice Address - Phone:808-934-4090
Practice Address - Fax:808-934-4089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X
HIPHY5633336M0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2018856OtherPK
HI54315901Medicaid