Provider Demographics
NPI:1861024812
Name:QUINTAL, KASIA
Entity Type:Individual
Prefix:
First Name:KASIA
Middle Name:
Last Name:QUINTAL
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 1:91-1742 ALA LOA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-1981
Mailing Address - Country:US
Mailing Address - Phone:808-779-5463
Mailing Address - Fax:
Practice Address - Street 1:94-060 FARRINGTON HWY
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1840
Practice Address - Country:US
Practice Address - Phone:808-676-8116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist