1053485144 NPI number — MS. MARY W MACMILLAN R.PH.

Table of content: MS. MARY W MACMILLAN R.PH. (NPI 1053485144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053485144 NPI number — MS. MARY W MACMILLAN R.PH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACMILLAN
Provider First Name:
MARY
Provider Middle Name:
W
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
R.PH.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053485144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
94-555 ALAPOAI ST
Provider Second Line Business Mailing Address:
APT 145
Provider Business Mailing Address City Name:
MILILANI
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96789-1674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-623-0977
Provider Business Mailing Address Fax Number:
808-623-0647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3288 MOANALUA RD
Provider Second Line Business Practice Location Address:
KP MOANALUA MED CTR ONCOLOGY CLINIC
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96819-1469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-423-8593
Provider Business Practice Location Address Fax Number:
808-432-8590
Provider Enumeration Date:
11/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835X0200X , with the licence number:  362 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)