Provider Demographics
NPI:1699265371
Name:NISHEK, KRISTIANNE SHELBY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KRISTIANNE
Middle Name:SHELBY
Last Name:NISHEK
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:PO BOX 1040
Mailing Address - Street 2:
Mailing Address - City:HANAPEPE
Mailing Address - State:HI
Mailing Address - Zip Code:96716-1040
Mailing Address - Country:US
Mailing Address - Phone:808-635-0546
Mailing Address - Fax:
Practice Address - Street 1:3735 UWAO STREET
Practice Address - Street 2:
Practice Address - City:HANAPEPE
Practice Address - State:HI
Practice Address - Zip Code:96716
Practice Address - Country:US
Practice Address - Phone:808-635-0546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3880183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist