Healthcare Provider Details

I. General information

NPI: 1972775997
Provider Name (Legal Business Name): FOODLAND SUPERMARKET LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 510 KAMEHAMEHA HWY
LAIE HI
96762
US

IV. Provider business mailing address

3536 HARDING AVE STE 100
HONOLULU HI
96816-2453
US

V. Phone/Fax

Practice location:
  • Phone: 808-293-9919
  • Fax: 808-293-9926
Mailing address:
  • Phone: 808-735-7202
  • Fax: 808-735-7275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY705
License Number StateHI

VIII. Authorized Official

Name: PATRICK ADAMS
Title or Position: DIR OF PHCY
Credential:
Phone: 808-735-7202