Provider Demographics
NPI:1538764568
Name:STATE OF HAWAII, DEPARTMENT OF HEALTH, STATE LABORATORIES DIVISION
Entity type:Organization
Organization Name:STATE OF HAWAII, DEPARTMENT OF HEALTH, STATE LABORATORIES DIVISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DESMOND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, D (ABMM)
Authorized Official - Phone:808-453-6650
Mailing Address - Street 1:2725 WAIMANO HOME RD
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-1401
Mailing Address - Country:US
Mailing Address - Phone:808-453-6653
Mailing Address - Fax:
Practice Address - Street 1:2725 WAIMANO HOME RD
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-1401
Practice Address - Country:US
Practice Address - Phone:808-453-6653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF HAWAII, DEPARTMENT OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory