Basic Information
| Provider Information | |||||||||
| NPI: | 1033419742 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OOKA | ||||||||
| FirstName: | KENNETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 E PUAINAKO ST | ||||||||
| Address2: | SAFEWAY PHARMACY | ||||||||
| City: | HILO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967205288 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 16-192 PILI MUA ST | ||||||||
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| City: | KEAAU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967498134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089300400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2010 | ||||||||
| LastUpdateDate: | 01/30/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PH2708 | HI | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.