Healthcare Provider Details

I. General information

NPI: 1215581020
Provider Name (Legal Business Name): ROBERT HETUE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ACE HETUE PHARMD

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 SCOTT CIR
HICKAM AFB HI
96853-5399
US

IV. Provider business mailing address

755 SCOTT CIR
HICKAM AFB HI
96853-5399
US

V. Phone/Fax

Practice location:
  • Phone: 808-458-7263
  • Fax:
Mailing address:
  • Phone: 808-458-7263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19955-40
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65051
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH-5236
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: