1609945187 NPI number — PHARM NEUT INC

Table of content: DR. JOHN M. FITZGERALD MD (NPI 1649232059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609945187 NPI number — PHARM NEUT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARM NEUT INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1609945187
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
850 W HIND DR
Provider Second Line Business Mailing Address:
#111
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96821-1845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-373-5151
Provider Business Mailing Address Fax Number:
808-373-5196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 W HIND DR
Provider Second Line Business Practice Location Address:
#111
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96821-1845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-373-5151
Provider Business Practice Location Address Fax Number:
808-373-5196
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PREBULA
Authorized Official First Name:
BONNIE
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CORP PRES V PRES
Authorized Official Telephone Number:
808-373-5151

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0001203859 . This is a "RX AMERICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 120385 . This is a "WALGREENS HEALTH INITIATI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1203859 . This is a "CAREMARK NABP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1203859 . This is a "AETNA NABP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1203859 . This is a "EXPRESS SCRIPTS NABP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1203859 . This is a "MEMBER HEALTH INC NABP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1203859 . This is a "WELL POINT NABP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00223933 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 12038 . This is a "PRESCRIPTION SOLUTIONS NA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1203859 . This is a "WEB MD NABP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1203859 . This is a "ARGUS NABP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1203859 . This is a "RESTAT NABP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25011701 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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