Basic Information
| Provider Information | |||||||||
| NPI: | 1184272957 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAUTISTA | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75-5595 PALANI RD | ||||||||
| Address2: | |||||||||
| City: | KAILUA KONA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967401663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083291632 | ||||||||
| FaxNumber: | 8083261628 | ||||||||
| Practice Location | |||||||||
| Address1: | 75-5595 PALANI RD | ||||||||
| Address2: | |||||||||
| City: | KAILUA KONA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967401663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083291632 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2019 | ||||||||
| LastUpdateDate: | 08/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PH-4304 | HI | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.