Provider Demographics
NPI:1881242766
Name:IIDA, MELISSA KUULEIALOHA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:KUULEIALOHA
Last Name:IIDA
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 1:3-2600 KAUMUALII HWY
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-2040
Mailing Address - Country:US
Mailing Address - Phone:808-245-8871
Mailing Address - Fax:808-245-1681
Practice Address - Street 1:3-2600 KAUMUALII HWY
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-2040
Practice Address - Country:US
Practice Address - Phone:808-245-8871
Practice Address - Fax:808-245-1681
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRPH-4067183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist