Healthcare Provider Details

I. General information

NPI: 1659643427
Provider Name (Legal Business Name): KALIHI PALAMA HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

952 N KING ST
HONOLULU HI
96817-4556
US

IV. Provider business mailing address

PO BOX 17460
HONOLULU HI
96817-0460
US

V. Phone/Fax

Practice location:
  • Phone: 808-791-6315
  • Fax:
Mailing address:
  • Phone: 808-791-4549
  • Fax: 808-845-4735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number809
License Number StateHI

VIII. Authorized Official

Name: EMMANUEL KINTU
Title or Position: CEO/EXECUTIVE DIRECTOR
Credential:
Phone: 808-791-6315