Healthcare Provider Details

I. General information

NPI: 1720370646
Provider Name (Legal Business Name): MINA CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-020 KAM HWY #2E
AIEA HI
96701-5159
US

IV. Provider business mailing address

3375 KOAPAKA STREET SUITE F245
HONOLULU HI
96819-1816
US

V. Phone/Fax

Practice location:
  • Phone: 808-275-4400
  • Fax: 808-484-2600
Mailing address:
  • Phone: 808-738-4540
  • Fax: 808-690-9174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY800
License Number StateHI

VIII. Authorized Official

Name: MR. ADEL ETINAS
Title or Position: PRESIDENT
Credential:
Phone: 808-738-4540