1588759617 NPI number — APOTHECARY OF KAUAI, INC.

Table of content: (NPI 1588759617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588759617 NPI number — APOTHECARY OF KAUAI, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APOTHECARY OF KAUAI, 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:
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:
1588759617
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 1113
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAPAA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96746-1113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-822-1447
Provider Business Mailing Address Fax Number:
808-823-0113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1177 KUHIO HWY
Provider Second Line Business Practice Location Address:
SUITE 113
Provider Business Practice Location Address City Name:
KAPAA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96746-1113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-822-1447
Provider Business Practice Location Address Fax Number:
808-823-0113
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAHR
Authorized Official First Name:
MILES
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
808-822-1447

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHY-344 , 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: 1201829 . This is a "NCPDP" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 001707-9 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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