Healthcare Provider Details

I. General information

NPI: 1023600715
Provider Name (Legal Business Name): DANIEL ALLEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67-1185 MAMALAHOA HWY
KAMUELA HI
96743-7304
US

IV. Provider business mailing address

PO BOX 10887
HILO HI
96721-5887
US

V. Phone/Fax

Practice location:
  • Phone: 808-885-2075
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH-3808
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: