Healthcare Provider Details

I. General information

NPI: 1033412895
Provider Name (Legal Business Name): KAPA'A PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 ELUA ST
LIHUE HI
96766-1213
US

IV. Provider business mailing address

4490 KOLOPA ST STE B
LIHUE HI
96766-2027
US

V. Phone/Fax

Practice location:
  • Phone: 808-246-6900
  • Fax: 808-246-6906
Mailing address:
  • Phone: 808-246-6900
  • Fax: 808-246-6906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY 793
License Number StateHI

VIII. Authorized Official

Name: KEVIN GLICK
Title or Position: MANAGING MEMBER
Credential:
Phone: 808-246-9100