Healthcare Provider Details

I. General information

NPI: 1740407840
Provider Name (Legal Business Name): KAISER FOUNDATION HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1292 WAIANUENUE AVE
HILO HI
96720-1228
US

IV. Provider business mailing address

1292 WAIANUENUE AVE
HILO HI
96720-1228
US

V. Phone/Fax

Practice location:
  • Phone: 808-934-4090
  • Fax: 808-934-4089
Mailing address:
  • Phone: 808-934-4090
  • Fax: 808-934-4089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License NumberPHY563
License Number StateHI

VIII. Authorized Official

Name: ROBERT SANDSTROM
Title or Position: PHARMACIST IN CHARGE
Credential: PHARMD
Phone: 808-934-4090