Organization
MINA PHARMACY LTC LLC
Active
Other names
Mina Pharmacy #15
Organization subpart
No
Provider details
NPI number
Authorized official
ADEL ETINAS RPH (PRESIDENT)
(808) 738-4540
Entity
Organization
Contact information
Practice address
275 W. KAAHUMANU AVE, #1C01, KAHULUI, HI 96732
(808) 856-3070
(808) 442-9635
Mailing address
3375 KOAPAKA STREET, F245, HONOLULU, HI 96819
(808) 738-4540
(808) 690-9174
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY-813
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1240821
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/25/2012
Last updated
05/06/2014
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