Healthcare Provider Details

I. General information

NPI: 1700928413
Provider Name (Legal Business Name): KAU COMMUNITY PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96-1115 KAMANI STREET SUITE 36
PAHALA HI
96777
US

IV. Provider business mailing address

PO BOX 299
PAHALA HI
96777-0299
US

V. Phone/Fax

Practice location:
  • Phone: 808-928-6252
  • Fax: 808-928-6408
Mailing address:
  • Phone: 808-928-6252
  • Fax: 808-928-6408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY-585
License Number StateHI

VIII. Authorized Official

Name: DR. FLOYD W. BARTY
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 808-732-8826