Healthcare Provider Details

I. General information

NPI: 1134566250
Provider Name (Legal Business Name): FOOD PANTRY, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5095 NAPILIHAU ST
LAHAINA HI
96761-8800
US

IV. Provider business mailing address

3536 HARDING AVE
HONOLULU HI
96816-2453
US

V. Phone/Fax

Practice location:
  • Phone: 808-669-1600
  • Fax: 808-669-2522
Mailing address:
  • Phone: 808-735-7202
  • Fax:

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 NumberPHY837
License Number StateHI

VIII. Authorized Official

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