Healthcare Provider Details

I. General information

NPI: 1164063079
Provider Name (Legal Business Name): KIMBERLY ANNE SPRENKEL RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-5995 KUAKINI HWY STE 513B
KAILUA KONA HI
96740-2124
US

IV. Provider business mailing address

PO BOX 3660
KAILUA KONA HI
96745-3660
US

V. Phone/Fax

Practice location:
  • Phone: 808-329-9012
  • Fax: 808-329-1005
Mailing address:
  • Phone: 410-382-2703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4257
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: