Healthcare Provider Details

I. General information

NPI: 1750930772
Provider Name (Legal Business Name): LELAND IBARA PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4469 WAIALO RD.
ELEELE HI
96705-0216
US

IV. Provider business mailing address

PO BOX 216
ELEELE HI
96705-0216
US

V. Phone/Fax

Practice location:
  • Phone: 808-335-0700
  • Fax:
Mailing address:
  • Phone: 808-335-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2605
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: