Healthcare Provider Details

I. General information

NPI: 1669514386
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 602 KAMEHAMEHA HWY
KANEOHE HI
96744-2098
US

IV. Provider business mailing address

45 602 KAMEHAMEHA HWY
KANEOHE HI
96744-2098
US

V. Phone/Fax

Practice location:
  • Phone: 808-432-3851
  • Fax: 808-432-3854
Mailing address:
  • Phone: 808-432-3851
  • Fax: 808-432-3854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License NumberPHY-138
License Number StateHI

VIII. Authorized Official

Name: STACEY NISHINA
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM D
Phone: 808-432-3851