Provider Demographics
NPI:1457967937
Name:ENRIQUEZ, CHERYL EMI
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:EMI
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E MAKAALA ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5144
Mailing Address - Country:US
Mailing Address - Phone:808-969-1062
Mailing Address - Fax:808-935-2979
Practice Address - Street 1:325 E MAKAALA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5144
Practice Address - Country:US
Practice Address - Phone:808-969-1062
Practice Address - Fax:808-935-2979
Is Sole Proprietor?:No
Enumeration Date:2020-09-19
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist