Healthcare Provider Details

I. General information

NPI: 1295372613
Provider Name (Legal Business Name): FOODLAND SUPER MARKET LIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 11/27/2023
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 HEKILI ST
KAILUA HI
96734-2848
US

IV. Provider business mailing address

108 HEKILI ST
KAILUA HI
96734-2848
US

V. Phone/Fax

Practice location:
  • Phone: 808-261-7329
  • Fax:
Mailing address:
  • Phone: 808-261-7329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TAMMY KAPUA HALEMANO
Title or Position: EXECUTIVE PHARMACY COORDINATOR
Credential:
Phone: 808-735-7209