Healthcare Provider Details

I. General information

NPI: 1245706969
Provider Name (Legal Business Name): ULTIMATE FOOT STORE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 W HIND DR STE 103
HONOLULU HI
96821-1849
US

IV. Provider business mailing address

707 RICHARDS ST STE 525
HONOLULU HI
96813-4623
US

V. Phone/Fax

Practice location:
  • Phone: 808-542-0736
  • Fax: 808-440-5251
Mailing address:
  • Phone: 808-542-0736
  • Fax: 808-440-5251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID R GRIFFITH
Title or Position: VP/TREASURER
Credential:
Phone: 808-542-0736