Healthcare Provider Details

I. General information

NPI: 1013369289
Provider Name (Legal Business Name): FOODLAND SUPERMARKET LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 ALA MOANA BLVD # 8000
HONOLULU HI
96814-4604
US

IV. Provider business mailing address

1450 ALA MOANA BLVD # 8000
HONOLULU HI
96814-4604
US

V. Phone/Fax

Practice location:
  • Phone: 808-949-2990
  • Fax: 808-949-2998
Mailing address:
  • Phone: 808-949-2990
  • Fax: 808-949-2998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY907
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PATRICK ADAMS
Title or Position: PHARMACY DIRECTOR/AO
Credential:
Phone: 808-735-7209