Basic Information
| Provider Information | |||||||||
| NPI: | 1619508546 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | UYETAKE | ||||||||
| FirstName: | KELLI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95-1119 KUALAPA ST | ||||||||
| Address2: | |||||||||
| City: | MILILANI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967894277 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 94-780 MEHEULA PKWY STE A | ||||||||
| Address2: | |||||||||
| City: | MILILANI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967892199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086236636 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2020 | ||||||||
| LastUpdateDate: | 01/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 2574 | HI | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.