Basic Information
| Provider Information | |||||||||
| NPI: | 1093135493 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KAISER FOUNDATION HEALTH PLAN INC | ||||||||
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| OtherOrganizationName: | KAISER FOUNDATION HEALTH PLAN INC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | KAISER KONA PHARMACY | ||||||||
| Address2: | 74-517 HONOKOHAU STREET | ||||||||
| City: | KAILUA-KONA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083344400 | ||||||||
| FaxNumber: | 8083344438 | ||||||||
| Practice Location | |||||||||
| Address1: | KAISER KONA PHARMACY | ||||||||
| Address2: | 74-517 HONOKOHAU STREET | ||||||||
| City: | KAILUA-KONA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083344400 | ||||||||
| FaxNumber: | 8083344438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2014 | ||||||||
| LastUpdateDate: | 02/16/2017 | ||||||||
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| AuthorizedOfficialLastName: | UYEDA | ||||||||
| AuthorizedOfficialFirstName: | CAROLYN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PHARMACIST IN CHARGE | ||||||||
| AuthorizedOfficialTelephone: | 8083344435 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336M0003X | PHY-853 | HI | Y | Suppliers | Pharmacy | Managed Care Organization Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 2145176 | 01 | PK | OTHER |