1700928413 NPI number — KAU COMMUNITY PHARMACY, INC.

Table of content: CYNTHIA ELLEN MAHONEY MSN, RN, CS (NPI 1710935051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700928413 NPI number — KAU COMMUNITY PHARMACY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAU COMMUNITY PHARMACY, 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:
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:
1700928413
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 299
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAHALA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96777-0299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-928-6252
Provider Business Mailing Address Fax Number:
808-928-6408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
96-1115 KAMANI STREET
Provider Second Line Business Practice Location Address:
SUITE 36
Provider Business Practice Location Address City Name:
PAHALA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-928-6252
Provider Business Practice Location Address Fax Number:
808-928-6408
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BARTY
Authorized Official First Name:
FLOYD
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
808-732-8826

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHY-585 , 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: 01273701 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000080846 . This is a "HMSA QUEST" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 1202504 . This is a "NABP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000008084-6 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 1202504 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".




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