Healthcare Provider Details

I. General information

NPI: 1801965389
Provider Name (Legal Business Name): PHARM NEUT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#1 GOVERNMENT RD
PAHOA HI
96778-1433
US

IV. Provider business mailing address

PO BOX 1433 #1 GOVERNMENT RD
PAHOA HI
96778-1433
US

V. Phone/Fax

Practice location:
  • Phone: 808-965-7535
  • Fax: 808-965-6159
Mailing address:
  • Phone: 808-965-7535
  • Fax: 808-965-6159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. BONNIE G PREBULA
Title or Position: CORP PRES V PRES
Credential:
Phone: 808-965-5629