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General NPI Number Information
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NPI Number | 1003138520
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Entity Type | Individual
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Provider Name | USAMA S EDRIS
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Gender | Male
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Dates
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Enumeration Date | 02/25/2010
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 520 LUNALILO HOME RD UNIT 6102
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City | HONOLULU
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State | HI
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Zip | 96825-1745
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Country | US
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Telephone | 718-614-2244
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Fax |
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Provider Business Mailing Address
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Address Line | 520 LUNALILO HOME RD UNIT 6102
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City | HONOLULU
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State | HI
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Zip | 96825-1745
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Country | US
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Telephone | 718-614-2244
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 047858-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 18230
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License Number State | HI
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