Healthcare Provider Details

I. General information

NPI: 1710066303
Provider Name (Legal Business Name): NAN KULI KAI PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 1845 WAIKOLOA ROAD #113
WAIKOLOA HI
96738-5001
US

IV. Provider business mailing address

PO BOX 385001
WAIKOLOA HI
96738-5001
US

V. Phone/Fax

Practice location:
  • Phone: 808-883-8484
  • Fax: 808-883-8871
Mailing address:
  • Phone: 808-883-8484
  • Fax: 808-883-8871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHY499
License Number StateHI

VIII. Authorized Official

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