Provider Demographics
NPI:1265529119
Name:KAHUKU HOSPITAL PHARMACY
Entity type:Organization
Organization Name:KAHUKU HOSPITAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORLISS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:808-293-9221
Mailing Address - Street 1:56-117 PUALALEA ST
Mailing Address - Street 2:
Mailing Address - City:KAHUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96731-2052
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:56-117 PUALALEA ST
Practice Address - Street 2:
Practice Address - City:KAHUKU
Practice Address - State:HI
Practice Address - Zip Code:96731-2052
Practice Address - Country:US
Practice Address - Phone:808-293-9221
Practice Address - Fax:808-293-2262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPHY3293336I0012X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3336I0012XSuppliersPharmacyInstitutional Pharmacy
Not Answered3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIJ05619Medicaid
1202035OtherOTHER ID NUMBER-COMMERCIAL NUMBER