Healthcare Provider Details

I. General information

NPI: 1790090165
Provider Name (Legal Business Name): TRACIE S. OKIMI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-1231 KA UKA BLVD
WAIPAHU HI
96797-4495
US

IV. Provider business mailing address

94-1231 KA UKA BLVD
WAIPAHU HI
96797-4495
US

V. Phone/Fax

Practice location:
  • Phone: 808-678-6102
  • Fax: 808-678-6109
Mailing address:
  • Phone: 808-678-6102
  • Fax: 808-678-6109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH-2478
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: