Healthcare Provider Details

I. General information

NPI: 1548579725
Provider Name (Legal Business Name): MINA CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S BERETANIA ST STE 110
HONOLULU HI
96814-1871
US

IV. Provider business mailing address

3375 KOAPAKA ST F245
HONOLULU HI
96819-1800
US

V. Phone/Fax

Practice location:
  • Phone: 808-955-6800
  • Fax: 808-955-6877
Mailing address:
  • Phone: 808-738-4540
  • Fax: 808-690-9174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY787
License Number StateHI

VIII. Authorized Official

Name: ADEL ETINAS
Title or Position: PRESIDENT,CEO
Credential:
Phone: 808-738-4540