Healthcare Provider Details

I. General information

NPI: 1215311188
Provider Name (Legal Business Name): MINA CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 FARRINGTON HWY STE 101
KAPOLEI HI
96707-2028
US

IV. Provider business mailing address

599 FARRINGTON HWY #101
KAPOLEI HI
96707-2028
US

V. Phone/Fax

Practice location:
  • Phone: 808-672-6760
  • Fax: 808-356-3392
Mailing address:
  • Phone: 808-672-6760
  • Fax: 808-356-3392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHY-887
License Number StateHI

VIII. Authorized Official

Name: ADEL ETINAS
Title or Position: PRESIDENT,CEO
Credential:
Phone: 808-222-9252