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Organization
MINA PHARMACY LTC, LLC
Active
Organization
MINA PHARMACY LTC, LLC
Active
Other names
MINA PHARMACY LTC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ADEL ETINAS (PRESIDENT)
(808) 738-4540
Entity
Organization
Contact information
Practice address
1251 KILAUEA AVE, #190C-1, HILO, HI 96720-8509
(808) 935-3100
(808) 935-6800
Mailing address
3375 KOAPAKA STREET, SUITE F245, HONOLULU, HI 96819-1816
(808) 738-4540
(808) 690-9174
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
PHY707
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1240124
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/15/2008
Last updated
09/08/2011
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