Basic Information
| Provider Information | |||||||||
| NPI: | 1144878281 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALANTAC | ||||||||
| FirstName: | JANINE | ||||||||
| MiddleName: | ROSE CHANG | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1620 N SCHOOL ST | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968171844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8088410724 | ||||||||
| FaxNumber: | 8088420726 | ||||||||
| Practice Location | |||||||||
| Address1: | 1620 N SCHOOL ST | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968171844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8088410724 | ||||||||
| FaxNumber: | 8088420726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2019 | ||||||||
| LastUpdateDate: | 09/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 1831 | HI | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.