Provider Demographics
NPI:1649661091
Name:NAPILI MARKET LAB #1297
Entity type:Organization
Organization Name:NAPILI MARKET LAB #1297
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 1:5095 NAPILIHAU ST
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-8800
Mailing Address - Country:US
Mailing Address - Phone:808-665-0028
Mailing Address - Fax:808-665-0029
Practice Address - Street 1:5095 NAPILIHAU ST
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-8800
Practice Address - Country:US
Practice Address - Phone:808-665-0028
Practice Address - Fax:808-665-0029
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOOD PANTRY 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
HI14-CP1-364291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory