Healthcare Provider Details

I. General information

NPI: 1952424400
Provider Name (Legal Business Name): MINA PHARMACY LTC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 01/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 KAPAHULU AVE 303
HONOLULU HI
96816
US

IV. Provider business mailing address

3375 KOAPAKA STREET SUITE F245
HONOLULU HI
96819-1816
US

V. Phone/Fax

Practice location:
  • Phone: 808-488-7500
  • Fax: 808-488-7505
Mailing address:
  • Phone: 808-738-4540
  • Fax: 808-690-9174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY-694
License Number StateHI

VIII. Authorized Official

Name: MR. ADEL ETINAS
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 808-738-4540