Healthcare Provider Details

I. General information

NPI: 1528023777
Provider Name (Legal Business Name): SHIIGI DRUG CO., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 KILAUEA AVE
HILO HI
96720-3013
US

IV. Provider business mailing address

333 KILAUEA AVE
HILO HI
96720-3013
US

V. Phone/Fax

Practice location:
  • Phone: 808-935-0001
  • Fax: 808-969-9833
Mailing address:
  • Phone: 808-935-0001
  • Fax: 808-969-9833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY-169
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPHY-169
License Number StateHI

VIII. Authorized Official

Name: LOUIS H MATSUKADO
Title or Position: PRESIDENT OWNER
Credential: RPH
Phone: 808-935-0001