Basic Information
| Provider Information | |||||||||
| NPI: | 1285265884 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUIZ | ||||||||
| FirstName: | ERIKA | ||||||||
| MiddleName: | CHIEMI IVERSEN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | BS PHARM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 94-780 MEHEULA PKWY STE A | ||||||||
| Address2: | |||||||||
| City: | MILILANI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967892199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086236636 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 94-780 MEHEULA PKWY STE A | ||||||||
| Address2: | |||||||||
| City: | MILILANI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967892199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086236636 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2020 | ||||||||
| LastUpdateDate: | 02/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 2076 | HI | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.