Healthcare Provider Details

I. General information

NPI: 1306881891
Provider Name (Legal Business Name): HAMAKUA FAMILY PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45-3551 MAMANE ST SUITE #4
HONOKAA HI
96727
US

IV. Provider business mailing address

PO BOX 1363
HONOKAA HI
96727-1363
US

V. Phone/Fax

Practice location:
  • Phone: 808-775-0496
  • Fax: 808-775-9786
Mailing address:
  • Phone: 808-775-0825
  • Fax: 808-775-9786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberW40065112-01
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHY-652
License Number StateHI

VIII. Authorized Official

Name: DR. EILEEN CHENG
Title or Position: PRESIDENT
Credential: PHARM.D.
Phone: 808-937-6379