Healthcare Provider Details

I. General information

NPI: 1871950055
Provider Name (Legal Business Name): ERIN KIKUE WADA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2016
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4366 KUKUI GROVE ST
LIHUE HI
96766-2006
US

IV. Provider business mailing address

4366 KUKUI GROVE ST
LIHUE HI
96766-2006
US

V. Phone/Fax

Practice location:
  • Phone: 808-246-5624
  • Fax:
Mailing address:
  • Phone: 808-246-5624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3897
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: