Healthcare Provider Details

I. General information

NPI: 1508959248
Provider Name (Legal Business Name): MELISSA YON JENKINS PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA YON KIM PHARM.D

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-5259 MAMALAHOA HWY APT D2
HOLUALOA HI
96725-9643
US

IV. Provider business mailing address

75-5259 MAMALAHOA HWY APT D2
HOLUALOA HI
96725-9643
US

V. Phone/Fax

Practice location:
  • Phone: 808-989-2724
  • Fax:
Mailing address:
  • Phone: 808-989-2724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH-2453
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS023496
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-53706
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberIND-933891
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: