Provider Demographics
NPI:1285780676
Name:SANJUME, GAVIN ALAIN (PHARMD)
Entity type:Individual
Prefix:
First Name:GAVIN
Middle Name:ALAIN
Last Name:SANJUME
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:GAVIN
Other - Middle Name:ALAIN
Other - Last Name:SANJUME
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:45 149 NAMOKU ST
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2303
Mailing Address - Country:US
Mailing Address - Phone:808-235-5524
Mailing Address - Fax:
Practice Address - Street 1:3501 RICE ST
Practice Address - Street 2:SUITE 209
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766
Practice Address - Country:US
Practice Address - Phone:808-240-0200
Practice Address - Fax:808-246-0721
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist