Healthcare Provider Details

I. General information

NPI: 1073882387
Provider Name (Legal Business Name): CENTRAL FILL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2011
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3375 KOAPAKA ST STE F245
HONOLULU HI
96819-1881
US

IV. Provider business mailing address

3375 KOAPAKA ST STE F245
HONOLULU HI
96819-1881
US

V. Phone/Fax

Practice location:
  • Phone: 808-738-4540
  • Fax: 808-690-9163
Mailing address:
  • Phone: 808-738-4540
  • Fax: 808-690-9163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number804
License Number StateHI

VIII. Authorized Official

Name: TIMOTHY MOSER
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 808-738-4540