1174692057 NPI number — MS. AEDUK NM KO RPH

Table of content: MS. AEDUK NM KO RPH (NPI 1174692057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174692057 NPI number — MS. AEDUK NM KO RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KO
Provider First Name:
AEDUK
Provider Middle Name:
NM
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
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:
1174692057
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:
725 KAPIOLANI BLVD APT 1806
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96813-6004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-593-1166
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TRIPLER ARMY MEDICAL CENTER
Provider Second Line Business Practice Location Address:
PHARMACY SERVICE
Provider Business Practice Location Address City Name:
TRIPLER AMC
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-433-6337
Provider Business Practice Location Address Fax Number:
808-433-6371
Provider Enumeration Date:
11/07/2006

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: 183500000X , with the licence number:  908 , 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)





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