Healthcare Provider Details

I. General information

NPI: 1659950988
Provider Name (Legal Business Name): KELSEY TRUJILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-449 AKOKI ST STE 102
WAIPAHU HI
96797-2732
US

IV. Provider business mailing address

45-206 WENA ST
KANEOHE HI
96744-2845
US

V. Phone/Fax

Practice location:
  • Phone: 808-671-5511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4614
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: