Provider Demographics
NPI:1538389747
Name:GO, KELLY (RPH)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:GO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 558
Mailing Address - Street 2:
Mailing Address - City:KAUNAKAKAI
Mailing Address - State:HI
Mailing Address - Zip Code:96748-0558
Mailing Address - Country:US
Mailing Address - Phone:808-553-5790
Mailing Address - Fax:808-553-5308
Practice Address - Street 1:28 KAMOI STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:KAUNAKAKAI
Practice Address - State:HI
Practice Address - Zip Code:96748-0558
Practice Address - Country:US
Practice Address - Phone:808-553-5790
Practice Address - Fax:808-553-5308
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist