1982860532 NPI number — FOODLAND SUPERMARKET LTD

Table of content: (NPI 1982860532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982860532 NPI number — FOODLAND SUPERMARKET LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOODLAND SUPERMARKET LTD
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:
Provider Other Organization Name Type Code:
6
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:
1982860532
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3536 HARDING AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96816-2453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-735-7202
Provider Business Mailing Address Fax Number:
808-735-7275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 771 KUHIO HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAPAA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-821-6979
Provider Business Practice Location Address Fax Number:
808-821-6977
Provider Enumeration Date:
08/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PHARMACY
Authorized Official Telephone Number:
808-735-7202

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHY709 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2116388 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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