Basic Information
| Provider Information | |||||||||
| NPI: | 1649818139 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LO-NGUYEN | ||||||||
| FirstName: | STEPHANIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95-207 LOEA PL | ||||||||
| Address2: | |||||||||
| City: | MILILANI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967896539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156084281 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1620 N SCHOOL ST | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968171844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8088410724 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2019 | ||||||||
| LastUpdateDate: | 12/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/15/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 3889 | HI | Y | 193400000X SINGLE SPECIALTY GROUP | Pharmacy Service Providers | Pharmacist |
No ID Information.