Provider Demographics
NPI:1184090599
Name:LEE, ELYSE MIDORI KANDA
Entity type:Individual
Prefix:MRS
First Name:ELYSE
Middle Name:MIDORI KANDA
Last Name:LEE
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 1:65-1271 KAWAIHAE RD
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-7369
Mailing Address - Country:US
Mailing Address - Phone:808-885-4418
Mailing Address - Fax:808-885-5854
Practice Address - Street 1:65-1271 KAWAIHAE RD
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-7369
Practice Address - Country:US
Practice Address - Phone:808-885-4418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist