Basic Information
| Provider Information | |||||||||
| NPI: | 1386152585 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LU | ||||||||
| FirstName: | BETSY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 46-047 KAMEHAMEHA HWY STE C | ||||||||
| Address2: | |||||||||
| City: | KANEOHE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967443736 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 46-047 KAMEHAMEHA HWY STE C | ||||||||
| Address2: | |||||||||
| City: | KANEOHE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967443736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082354551 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2018 | ||||||||
| LastUpdateDate: | 01/22/2018 | ||||||||
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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 | 233556 | MA | N | Pharmacy Service Providers | Pharmacist | 183500000X | 2974 | HI | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.