Provider Demographics
NPI:1366594640
Name:LEGAWA, KIMBERLY NAOMI (RPH)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NAOMI
Last Name:LEGAWA
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 1:1176 KALAMA PAKA PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-2886
Mailing Address - Country:US
Mailing Address - Phone:808-394-8771
Mailing Address - Fax:
Practice Address - Street 1:1010 PENSACOLA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2118
Practice Address - Country:US
Practice Address - Phone:808-432-2375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH2179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist