Provider Demographics
NPI:1487159083
Name:CHANG PACPACO, KRISTI ANNE HIDEMI (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:ANNE HIDEMI
Last Name:CHANG PACPACO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-2123
Mailing Address - Country:US
Mailing Address - Phone:808-621-7772
Mailing Address - Fax:808-621-1485
Practice Address - Street 1:925 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-2123
Practice Address - Country:US
Practice Address - Phone:808-621-7772
Practice Address - Fax:808-621-1485
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2360183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist