Provider Demographics
NPI:1295126647
Name:SACK N SAVE LAB#26
Entity type:Organization
Organization Name:SACK N SAVE LAB#26
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:808-885-2075
Mailing Address - Street 1:2100 KANOELEHUA AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-6500
Mailing Address - Country:US
Mailing Address - Phone:808-959-7300
Mailing Address - Fax:866-427-1286
Practice Address - Street 1:2100 KANOELEHUA AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-6500
Practice Address - Country:US
Practice Address - Phone:808-959-7300
Practice Address - Fax:866-427-1286
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOODLAND SUPERMARKET LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI14CP1-357291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory