Healthcare Provider Details

I. General information

NPI: 1972861276
Provider Name (Legal Business Name): TIFFANY PUALEI SANTORE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67-1185 MAMALAHOA HIGHWAY # C101
KAMUELA HI
96743-8594
US

IV. Provider business mailing address

73-1105 NUUANU PL UNIT B102
KAILUA KONA HI
96740-8594
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 Number3204
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: