Healthcare Provider Details

I. General information

NPI: 1669429239
Provider Name (Legal Business Name): NORTH SHORE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 08/22/2020
Certification Date:
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 385
KAHUKU HI
96731-0385
US

V. Phone/Fax

Practice location:
  • Phone: 808-293-9514
  • Fax: 808-293-8699
Mailing address:
  • Phone: 808-293-9514
  • Fax: 808-293-8699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY155
License Number StateHI

VIII. Authorized Official

Name: MR. HARRY CAROLD BJORNSON
Title or Position: REGISTERED PHARMACIST
Credential:
Phone: 80829399514