Healthcare Provider Details

I. General information

NPI: 1659760734
Provider Name (Legal Business Name): MINA PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

3375 KOAPAKA ST SUITE F245
HONOLULU HI
96819-1800
US

IV. Provider business mailing address

275 W KAAHUMANU AVE SUITE# 1C01A
KAHULUI HI
96732-1629
US

V. Phone/Fax

Practice location:
  • Phone: 808-222-9252
  • Fax: 808-356-3392
Mailing address:
  • Phone: 808-856-3070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberPHY-813
License Number StateHI

VIII. Authorized Official

Name: MR. ADEL ETINAS
Title or Position: PRESIDENT,CEO
Credential: RPH
Phone: 808-222-9252