=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215078084
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PUANANI PIILEHUA HURLEY WATAOKA PHARM.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1010 PENSACOLA ST KAISER PERMANENTE HONOLULU CLINIC
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-2118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-432-2065
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 99-1383 AIEA HEIGHTS DR
-----------------------------------------------------
City | AIEA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96701-3019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-485-2666
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PH2402
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------