Provider Demographics
NPI:1083025829
Name:LUM, MERVIN
Entity type:Individual
Prefix:
First Name:MERVIN
Middle Name:
Last Name:LUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-424 PUNONO ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2567
Mailing Address - Country:US
Mailing Address - Phone:808-226-8332
Mailing Address - Fax:
Practice Address - Street 1:4850 KAPOLEI PKWY
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-3203
Practice Address - Country:US
Practice Address - Phone:808-674-1156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI7171835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy