GREGORY FORMANACK (NPI# 1063830644) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063830644 |
| Entity Type | Individual |
| Full Name | GREGORY FORMANACK |
| Credential | R.PH. |
| Practice Address |
74-5465 Kamakaeha Ave Kailua Kona HI 96740-1648 |
| Mailing Address |
77-104 Kalaniuka St Holualoa HI 96725-9728 |
| Practice Telephone | 8083261707 |
| Practice Fax Number | 8083341173 |
| Mailing Telephone | 8083261707 |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2014-04-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 183500000X | Pharmacist | 3046 | MT | Pharmacy Service Providers |
| Y | 183500000X | Pharmacist | 1301 | HI | Pharmacy Service Providers |
| Street Address |
74-5465 KAMAKAEHA AVE |
| City | KAILUA KONA |
| State | HI |
| Zip Code | 96740-1648 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669809687 | Megan Cho Venegas | Pharmacist | 74-5465 Kamakaeha Ave, Kailua Kona, HI 96740-1648 | 2013-10-04 |
| 1871524926 | K Mart Corp | Pharmacy | 74-5465 Kamakaeha Ave, Kailua Kona, HI 96740-1648 | 2006-07-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649870577 | Elise Christine Duvua | Massage Therapist | 75-127 Lunadule Rd. Suite #5, Kailua Kona, HI 96740 | 2020-10-29 |
| 1356954820 | Zellda Keath | Acupuncturist | Kohanaiki Club Services, 73-2055 Ala Kohanaiki, Kailua-kona, HI 96740 | 2020-08-25 |
| 1467070979 | Safeway Inc | Durable Medical Equipment & Medical Supplies | 75-971 Henry St, Kailua Kona, HI 96740 | 2020-07-10 |
| 1275182040 | Jessica Marie Penaranda | Pharmacist | 5595 Palani Road, Kona, HI 96740 | 2019-09-05 |
| 1558870600 | Malia Lewis Vannatta | Nurse Practitioner | 75-184 Hulalalai Rd, 302, Kailua Kona, HI 96740 | 2017-09-20 |
| 1043759087 | Paul Michael Heller | Acupuncturist | 72 3996 Hawaii Belt Rd, Kailua Kona, HI 96740 | 2017-02-22 |
| 1255787974 | John Fujita | Pharmacist | 74-5456 Kamakaeha Ave, Kailua Kona, HI 96740 | 2016-05-11 |
| 1326425083 | Lauren Deweese | Massage Therapist | 76-6194 Holualoa Beach Rd, Unit 6, Kailua-kona, HI 96740 | 2015-05-01 |
| 1073907754 | Kathleen Marie Coyle | Massage Therapist | 76-217 Keakealani Street, Kailua Kona, HI 96740 | 2015-03-20 |
| 1841609971 | Shellie R Norman | Nurse Practitioner | 75-5995 Kuakini Hwy Ste 443&445, Kailua Kona, HI 96740 | 2014-08-01 |
| Find all providers in zip 96740 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164063079 | Kimberly Anne Sprenkel | Pharmacist | 75-5995 Kuakini Hwy Ste 513b, Kailua Kona, HI 96740-2124 | 2019-10-02 |
| 1528546413 | Necole Miyazaki | Pharmacist | 78-6831 Alii Dr Ste 101, Kailua Kona, HI 96740-2440 | 2018-08-01 |
| 1255787974 | John Fujita | Pharmacist | 74-5456 Kamakaeha Ave, Kailua Kona, HI 96740 | 2016-05-11 |
| 1588018493 | Craig Pivo | Pharmacist | 75-6226 Piena Pl, Kailua Kona, HI 96740-7948 | 2016-04-17 |
| 1528464971 | Micheal Hamilton | Pharmacist | 76-6172 Kumu Pl, Kailua Kona, HI 96740-4330 | 2014-11-12 |
| 1972924827 | Timothy C Bedrosian | Pharmacist | 73-4400 Paiaha St, Kailua Kona, HI 96740-9313 | 2013-12-19 |
| 1669809687 | Megan Cho Venegas | Pharmacist | 74-5465 Kamakaeha Ave, Kailua Kona, HI 96740-1648 | 2013-10-04 |
| 1730454380 | Peter J Morrow | Pharmacist | 75-6040 Alii Dr # 707, Kailua Kona, HI 96740-2310 | 2012-03-15 |
| 1134420458 | Michael Sylva | Pharmacist | 75-5751 Kuakini Hwy Ste 104, Kailua Kona, HI 96740-1705 | 2010-11-03 |
| 1851582118 | Kathleen Amazona-schmidt | Pharmacist | 74-802 Uluaoa St, Kailua Kona, HI 96740-1502 | 2007-08-01 |
| Find all providers in KAILUA KONA | ||||
| City | KAILUA KONA |
| Zip Code | 96740 |
Please comment or provide details below to improve the information on GREGORY FORMANACK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.