1801965389 NPI number — PHARM NEUT INC

Table of content: (NPI 1801965389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801965389 NPI number — PHARM NEUT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARM NEUT INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PAHOA RX PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801965389
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1433
Provider Second Line Business Mailing Address:
#1 GOVERNMENT RD
Provider Business Mailing Address City Name:
PAHOA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96778-1433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-965-7535
Provider Business Mailing Address Fax Number:
808-965-6159

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
#1 GOVERNMENT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAHOA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96778-1433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-965-7535
Provider Business Practice Location Address Fax Number:
808-965-6159
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PREBULA
Authorized Official First Name:
BONNIE
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CORP PRES V PRES
Authorized Official Telephone Number:
808-965-5629

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NABP1202667 . This is a "RX SOLUTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02592601 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: NABP1202667 . This is a "EXPRESS SCRIPTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: NABP1202667028900001 . This is a "ARGUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: NABP0001202667 . This is a "RX AMERICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: NABP1202667 . This is a "RESTAT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000001342NABP1202667 . This is a "CAREMARK" identifier . This identifiers is of the category "OTHER".
  • Identifier: NABP1202667 . This is a "WALGREENS HEALTH INITATIV" identifier . This identifiers is of the category "OTHER".
  • Identifier: NABP1202667 . This is a "PROSERV" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000228007 . This is a "HMSA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1202667 . This is a "MEMBER HEALTH INC" identifier . This identifiers is of the category "OTHER".




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