Provider Demographics
NPI:1730454562
Name:IBIA, LENORA LEE (BS OF PHARMACY)
Entity type:Individual
Prefix:MRS
First Name:LENORA
Middle Name:LEE
Last Name:IBIA
Suffix:
Gender:F
Credentials:BS OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 NUHOU ST
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-8002
Mailing Address - Country:US
Mailing Address - Phone:808-241-4009
Mailing Address - Fax:808-241-4006
Practice Address - Street 1:4300 NUHOU ST
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-8002
Practice Address - Country:US
Practice Address - Phone:808-241-4009
Practice Address - Fax:808-241-4006
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH1427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist