Provider Demographics
NPI:1811425358
Name:KIMBALL, WHA J (PHARMD)
Entity type:Individual
Prefix:
First Name:WHA
Middle Name:J
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1778 ALA MOANA BLVD
Mailing Address - Street 2:#208
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815
Mailing Address - Country:US
Mailing Address - Phone:727-667-8604
Mailing Address - Fax:
Practice Address - Street 1:1778 ALA MOANA BLVD STE 208
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-5312
Practice Address - Country:US
Practice Address - Phone:727-667-8604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
HI3842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy