Healthcare Provider Details

I. General information

NPI: 1851395289
Provider Name (Legal Business Name): WALLACE-JONES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 HAIKU RD STE 127
HAIKU HI
96708-4800
US

IV. Provider business mailing address

810 HAIKU RD STE 127
HAIKU HI
96708-4800
US

V. Phone/Fax

Practice location:
  • Phone: 808-575-7522
  • Fax: 808-575-2198
Mailing address:
  • Phone: 808-575-7522
  • Fax: 808-575-2198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY-567
License Number StateHI

VIII. Authorized Official

Name: MR. THOMAS PAUL JONES
Title or Position: PRESIDENT, PHARMACIST
Credential: R.PH.
Phone: 808-575-7522