Healthcare Provider Details

I. General information

NPI: 1649477084
Provider Name (Legal Business Name): ERIKA GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1264 KAAHUMANU ST
PEARL CITY HI
96782-3252
US

IV. Provider business mailing address

47-388 HUI IWA ST
KANEOHE HI
96744-4428
US

V. Phone/Fax

Practice location:
  • Phone: 808-483-3078
  • Fax:
Mailing address:
  • Phone: 808-239-3204
  • Fax: 808-239-3206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2401
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2401
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: