Provider Demographics
NPI:1902952278
Name:ITANO, JENNIFER KIMIE (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:KIMIE
Last Name:ITANO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 MANANAI PL
Mailing Address - Street 2:#11D
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-5334
Mailing Address - Country:US
Mailing Address - Phone:808-487-0615
Mailing Address - Fax:
Practice Address - Street 1:468 MANANAI PL
Practice Address - Street 2:#11D
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-5334
Practice Address - Country:US
Practice Address - Phone:808-487-0615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-2546183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist