# MINA PHARMACY LTC LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mina Pharmacy \#15
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740548981
- **Authorized official:** ADEL ETINAS RPH (PRESIDENT)
- **Authorized official phone:** (808) 738-4540

## Contact information

- **Practice address:** 275 W. KAAHUMANU AVE, \#1C01, KAHULUI, HI 96732
- **Practice address phone:** (808) 856-3070
- **Practice address fax:** (808) 442-9635
- **Mailing address:** 3375 KOAPAKA STREET, F245, HONOLULU, HI 96819
- **Mailing address phone:** (808) 738-4540
- **Mailing address fax:** (808) 690-9174

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | PHY-813 | HI | Yes |

## Other

- **Enumeration date:** 04/25/2012
- **Last updated:** 05/06/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1240821 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |