Healthcare Provider Details

I. General information

NPI: 1790838654
Provider Name (Legal Business Name): MELISSA ANN BUMGARDNER PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-5751 KUAKINI HWY STE 101A
KAILUA KONA HI
96740
US

IV. Provider business mailing address

75-5751 KUAKINI HWY
KAILUA KONA HI
96740-1752
US

V. Phone/Fax

Practice location:
  • Phone: 808-326-5629
  • Fax:
Mailing address:
  • Phone: 808-326-5629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number117907-9
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number4059
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: