Provider Demographics
NPI:1043350630
Name:MAC MASTER, GRACE HUNGSOP (RPH)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:HUNGSOP
Last Name:MAC MASTER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2668 WAOLANI AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1368
Mailing Address - Country:US
Mailing Address - Phone:808-432-3452
Mailing Address - Fax:808-432-3459
Practice Address - Street 1:201 HAMAKUA DR
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3984
Practice Address - Country:US
Practice Address - Phone:808-432-3452
Practice Address - Fax:808-432-3459
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-1153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist