Healthcare Provider Details

I. General information

NPI: 1295879237
Provider Name (Legal Business Name): GARDEN ISLAND PHARMACY SERV, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 KOLOA RD BX 160
KOLOA HI
96756-8604
US

IV. Provider business mailing address

5330 KOLOA RD
KOLOA HI
96756-8604
US

V. Phone/Fax

Practice location:
  • Phone: 808-338-0200
  • Fax:
Mailing address:
  • Phone: 808-338-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY-406
License Number StateHI

VIII. Authorized Official

Name: STEWART L SWACKER
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 808-338-0200