Healthcare Provider Details

I. General information

NPI: 1063820009
Provider Name (Legal Business Name): HAWAII MOTHERS' MILK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 10/01/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST
HONOLULU HI
96826-1001
US

IV. Provider business mailing address

1319 PUNAHOU ST
HONOLULU HI
96826-1001
US

V. Phone/Fax

Practice location:
  • Phone: 808-947-6920
  • Fax: 808-441-9922
Mailing address:
  • Phone: 808-947-6920
  • Fax: 808-441-9922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number40404586 - 01
License Number StateHI

VIII. Authorized Official

Name: MS. PATRICIA ANE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 808-947-6920