Healthcare Provider Details

I. General information

NPI: 1003876376
Provider Name (Legal Business Name): DIANE MICHELLE HENRY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84-770 UPENA ST
WAIANAE HI
96792-1936
US

IV. Provider business mailing address

84-770 UPENA ST
WAIANAE HI
96792-1936
US

V. Phone/Fax

Practice location:
  • Phone: 808-492-8258
  • Fax:
Mailing address:
  • Phone: 808-492-8258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57976
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH-3145
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13581
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: