Healthcare Provider Details

I. General information

NPI: 1235442849
Provider Name (Legal Business Name): KO OLAULOA HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56-119 PUALALEA ST
KAHUKU HI
96731-2052
US

IV. Provider business mailing address

PO BOX 395
KAHUKU HI
96731-0395
US

V. Phone/Fax

Practice location:
  • Phone: 808-293-9514
  • Fax:
Mailing address:
  • Phone: 808-293-9514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPHY788
License Number StateHI

VIII. Authorized Official

Name: TERRENCE H ARATANI
Title or Position: CEO
Credential:
Phone: 808-792-3840