Healthcare Provider Details

I. General information

NPI: 1780996579
Provider Name (Legal Business Name): RAINBOW PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2349 S KIHEI RD #4
KIHEI HI
96753-7202
US

IV. Provider business mailing address

2349 S KIHEI RD #4
KIHEI HI
96753-7202
US

V. Phone/Fax

Practice location:
  • Phone: 808-879-9924
  • Fax: 808-879-9925
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY-786
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY786
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPHY786
License Number StateHI

VIII. Authorized Official

Name: DR. KERT SHUSTER
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM.D, MT
Phone: 808-879-9924