Healthcare Provider Details

I. General information

NPI: 1114070448
Provider Name (Legal Business Name): JEFFREY KEN SASAKI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-1480 MOANIANI ST
WAIPAHU HI
96797-4632
US

IV. Provider business mailing address

3018 POLOHI PL
HONOLULU HI
96817-1162
US

V. Phone/Fax

Practice location:
  • Phone: 808-432-3150
  • Fax: 808-432-3155
Mailing address:
  • Phone: 808-595-3172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH-951
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: