Provider Demographics
NPI:1760980056
Name:MARTINEAU, JANICE
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:MARTINEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 060 FARRINGTON HWY
Mailing Address - Street 2:LONGS PHARMACY DEPT
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797
Mailing Address - Country:US
Mailing Address - Phone:808-676-8116
Mailing Address - Fax:808-678-0260
Practice Address - Street 1:94 060 FARRINGTON HWY
Practice Address - Street 2:LONGS PHARMACY DEPT
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797
Practice Address - Country:US
Practice Address - Phone:808-676-8116
Practice Address - Fax:808-678-0260
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist