# KAUAI REGION PHARMACY WEST

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174107254
- **Authorized official:** KENNETH M VANDEN BUSSCHE (LEAD RETAIL PHARMACIST)
- **Authorized official phone:** (808) 338-2450

## Contact information

- **Practice address:** 4643 WAIMEA CANYON DR., WAIMEA, HI 96796
- **Practice address phone:** (808) 338-2450
- **Practice address fax:** (808) 338-2451
- **Mailing address:** PO BOX 337, WAIMEA, HI 96796
- **Mailing address phone:** (808) 338-2450
- **Mailing address fax:** (808) 338-2451

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 05/06/2021
- **Last updated:** 05/06/2021