Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Other names
KAISER KOOLAU CLINIC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY NISHINA PHARM D (PHARMACIST IN CHARGE)
(808) 432-3851
Entity
Organization
Contact information
Practice address
45 602 KAMEHAMEHA HWY, KANEOHE, HI 96744-2098
(808) 432-3851
(808) 432-3854
Mailing address
45 602 KAMEHAMEHA HWY, KANEOHE, HI 96744-2098
(808) 432-3851
(808) 432-3854
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
Primary
PHY-138
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2017880
PK
—
05
—
54325801
—
HI
Enumeration date
02/12/2007
Last updated
02/28/2017
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