Provider Demographics
NPI:1770635906
Name:IBUYAN, DONNA (RPH)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:IBUYAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 880642
Mailing Address - Street 2:
Mailing Address - City:PUKALANI
Mailing Address - State:HI
Mailing Address - Zip Code:96788-0642
Mailing Address - Country:US
Mailing Address - Phone:808-662-6945
Mailing Address - Fax:808-662-6940
Practice Address - Street 1:910 WAINEE ST
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-1622
Practice Address - Country:US
Practice Address - Phone:808-662-6945
Practice Address - Fax:808-662-6940
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-2367183500000X
GUPH-0123183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist