Healthcare Provider Details

I. General information

NPI: 1962395780
Provider Name (Legal Business Name): PEARL CITY HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 KAMEHAMEHA HWY STE 8
PEARL CITY HI
96782-2521
US

IV. Provider business mailing address

PO BOX 11603
HONOLULU HI
96828-0603
US

V. Phone/Fax

Practice location:
  • Phone: 808-456-5553
  • Fax: 808-455-6520
Mailing address:
  • Phone: 808-456-5553
  • Fax: 808-455-6520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER NOWICKI
Title or Position: CO- OWNER
Credential:
Phone: 808-456-5553