Healthcare Provider Details

I. General information

NPI: 1598185357
Provider Name (Legal Business Name): THE QUEEN'S MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-2141 FORT WEAVER RD
EWA BEACH HI
96706-1993
US

IV. Provider business mailing address

91-2141 FORT WEAVER RD
EWA BEACH HI
96706-1993
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-3281
  • Fax:
Mailing address:
  • Phone: 808-691-3281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberPHY - 846
License Number StateHI

VIII. Authorized Official

Name: BEVERLY SAKUDA
Title or Position: MANAGER, PHARMACY SERVICES
Credential:
Phone: 808-691-3614