Organization
KAILUA FAMILY PHARMACY LLC
Active
Other names
ElixRx
Organization subpart
No
Provider details
NPI number
Authorized official
JAKE BLECHTA (PRESIDENT)
(808) 397-1336
Entity
Organization
Contact information
Practice address
1090 KEOLU DR STE 112113, KAILUA, HI 96734-3871
(808) 260-9894
(808) 260-9957
Mailing address
1090 KEOLU DR, STE #112/113, KAILUA, HI 96734-3871
(808) 260-9894
(808) 260-9957
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY-856
HI
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2148405
PK
—
Enumeration date
10/21/2014
Last updated
02/08/2016
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