Healthcare Provider Details

I. General information

NPI: 1588050983
Provider Name (Legal Business Name): RAINBOW PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 SEVENTH ST
LANAI CITY HI
96763
US

IV. Provider business mailing address

PO BOX 631255
LANAI CITY HI
96763-1255
US

V. Phone/Fax

Practice location:
  • Phone: 808-565-9332
  • Fax: 808-565-9333
Mailing address:
  • Phone: 808-565-9333
  • Fax: 808-565-9332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY885
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY885
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPHY885
License Number StateHI

VIII. Authorized Official

Name: KERT SHUSTER
Title or Position: OWNER/PHARMACIST-IN-CHARGE
Credential: PHARM.D.
Phone: 808-879-9924