Healthcare Provider Details

I. General information

NPI: 1093135493
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KAISER KONA PHARMACY 74-517 HONOKOHAU STREET
KAILUA-KONA HI
96740
US

IV. Provider business mailing address

KAISER KONA PHARMACY 74-517 HONOKOHAU STREET
KAILUA-KONA HI
96740
US

V. Phone/Fax

Practice location:
  • Phone: 808-334-4400
  • Fax: 808-334-4438
Mailing address:
  • Phone: 808-334-4400
  • Fax: 808-334-4438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License NumberPHY-853
License Number StateHI

VIII. Authorized Official

Name: CAROLYN UYEDA
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 808-334-4435