Healthcare Provider Details

I. General information

NPI: 1093860959
Provider Name (Legal Business Name): FOODLAND SUPERMARKET LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 1185 MAMALAHOA HWY
KAMUELA HI
96743
US

IV. Provider business mailing address

3536 HARDING AVE
HONOLULU HI
96816-2453
US

V. Phone/Fax

Practice location:
  • Phone: 808-885-2075
  • Fax: 808-885-2061
Mailing address:
  • Phone: 808-732-0791
  • Fax: 808-735-7275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY633
License Number StateHI

VIII. Authorized Official

Name: PATRICK ADAMS
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 808-735-7202