DR. JARRED B PRUDENCIO (NPI# 1649721994) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649721994 |
| Entity Type | Individual |
| Full Name | DR. JARRED B PRUDENCIO |
| Credential | PHARM.D. |
| Practice Address |
45 Mohouli St Ste 101 Hilo HI 96720-7210 |
| Mailing Address |
200 W Kawili St Hilo HI 96720-4075 |
| Practice Telephone | 8089324215 |
| Mailing Telephone | 8089372032 |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2016-10-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1835P0018X |
Pharmacist Specialization: Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
PH-4021 | HI | Pharmacy Service Providers |
| N | 1835P2201X |
Pharmacist Specialization: Ambulatory Care |
PH-4021 | HI | Pharmacy Service Providers |
| Street Address |
45 MOHOULI ST STE 101 |
| City | HILO |
| State | HI |
| Zip Code | 96720-7210 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629529805 | Michelle Saori Kim | Pharmacist | 45 Mohouli St Ste 101, Hilo, HI 96720-7210 | 2016-10-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184230807 | Iane Dantas Franca | Counselor | 1045 Kilauea Avenue, Hilo, HI 96720 | 2020-09-17 |
| 1467086280 | Integrated Medicine Institute, Inc. | Nurse Practitioner | 868 Ululani Street Suite 106, Hilo, HI 96720 | 2020-03-02 |
| 1316405004 | Stephanie M Higa | Registered Nurse | Hc01 Stainback Hwy., Hilo, HI 96720 | 2019-03-12 |
| 1790257418 | Blake Honda | Behavior Technician | 879b Manono St., Hilo, HI 96720 | 2018-12-19 |
| 1184101446 | The Salvation Army | Substance Abuse Rehabilitation Facility | 105 Hokulani Street, Hilo, HI 96720 | 2018-07-19 |
| 1013434505 | Taliesin Erika Kiele Sumner | Student in an Organized Health Care Education/Training Program | 214 Waianueanue Ave., #209, Hilo, HI 96720 | 2017-08-24 |
| 1154844454 | David Fundakowski | Behavioral Analyst | 69 Railroad Avenue, Hawaii Behavioral Health, Hilo, HI 96720 | 2017-07-19 |
| 1407381668 | Veronica Brockway | Counselor | 69 Railroad Ave Ste 3, Hilo, HI 96720 | 2017-04-25 |
| 1477092682 | Frederique Montpetit | Student in an Organized Health Care Education/Training Program | 1257 Kilauea Ave Suite 100, Hilo Family Dental Center, Hilo, HI 96720 | 2017-02-21 |
| 1427592666 | Amber Kainoa Arthur | Behavioral Analyst | 234 Waianuenue Ave. Suite 215, Hilo, HI 96720 | 2016-12-07 |
| Find all providers in zip 96720 | ||||
| Taxonomy Code | 1835P0018X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| Specialization | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management. |
| Notes: Source: National Uniform Claim Committee, 2007 [1/1/2008: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790010593 | Mok T Chong | Pharmacist | 200 W Kawili St, Hilo, HI 96720-4075 | 2009-10-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023367695 | Blain Hisami Yoshinobu | Pharmacist | 520 Lunalilo Home Rd Unit 328, Honolulu, HI 96825-1714 | 2012-08-29 |
| 1528391778 | Justin Kiyoshi Yoshida | Pharmacist | Us Army Health Clinic - Schofield Barracks, Pharmacy Service Bldg 676, Schofield Barracks, HI 96857-5460 | 2009-09-04 |
| 1760638076 | Kathy Cazares | Pharmacist | 98-500 Lulu St, Aiea, HI 96701-2165 | 2008-08-18 |
| 1902856636 | Lawrence Wung Kee Chinn | Pharmacist | 459 Patterson Rd # 119, Honolulu, HI 96819-1522 | 2006-05-11 |
| 1811999808 | Ryan Tatsumoto | Pharmacist | Bldg 682 Rm 236, Usahc - Schofield Barracks, Schofield Barracks, HI 96857 | 2005-08-10 |
| 1366053084 | Jane Choi | Pharmacist | 615 Piikoi St Ste 105, Honolulu, HI 96814-3139 | 2020-08-14 |
| 1295355956 | Sarah Horng | Pharmacist | 1 Jarrett White Rd, Tripler Army Medical Center, HI 96859-5001 | 2020-04-23 |
| 1407482664 | Lehua Kay | Pharmacist | 45-710 Keaahala Rd, Kaneohe, HI 96744-3597 | 2020-03-19 |
| 1902452840 | Grace Marie Gomes | Pharmacist | 459 Patterson Rd, Honolulu, HI 96819-1522 | 2019-08-15 |
| 1255812137 | Bay Clinic Inc | Pharmacist | 16-192 Pili Mua St, Keaau, HI 96749-8134 | 2018-08-28 |
| Find all providers with the same taxonomy | ||||
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| 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.