# MINA PHARMACY LTC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mina pharmacy\#6
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780734376
- **Authorized official:** MR. ADEL ETINAS RPH (PRESIDENT,CEO)
- **Authorized official phone:** (808) 738-4540

## Contact information

- **Practice address:** 75-5995 KUAKINI HWY, \#513A, KAILUA KONA, HI 96740-2124
- **Practice address phone:** (808) 329-1000
- **Practice address fax:** (808) 329-1005
- **Mailing address:** 3375 KOAPAKA STREET,, SUITE F245, HONOLULU, HI 96819-1816
- **Mailing address phone:** (808) 738-4540
- **Mailing address fax:** (808) 690-9174

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | PHY-687 | HI | Yes |

## Other

- **Enumeration date:** 01/12/2007
- **Last updated:** 10/03/2013