Healthcare Provider Details

I. General information

NPI: 1447323100
Provider Name (Legal Business Name): MALAMA COMPOUNDING PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81-6629 MAMALAHOA HWY
KEALAKEKUA HI
96750-8130
US

IV. Provider business mailing address

81-6629 MAMALAHOA HWY
KEALAKEKUA HI
96750-8130
US

V. Phone/Fax

Practice location:
  • Phone: 808-324-6888
  • Fax: 808-324-7888
Mailing address:
  • Phone: 808-324-6888
  • Fax: 808-324-7888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHY-142
License Number StateHI

VIII. Authorized Official

Name: CHAI LOH NEO
Title or Position: VP
Credential:
Phone: 808-324-6888