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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