Organization
MINA PHARMACY LTC LLC
Active
Other names
Mina Pharmacy #14
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY MOSER (DIRECTOR OF PHARMACY)
(808) 738-4540
Entity
Organization
Contact information
Practice address
275 W KAAHUMANU AVE STE 1C01A, KAHULUI, HI 96732-1629
(808) 856-8030
(808) 442-9634
Mailing address
3375 KOAPAKA ST STE F245, HONOLULU, HI 96819-1881
(808) 738-4540
(808) 690-9174
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
PHY-812
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1240833
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/26/2012
Last updated
04/26/2012
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