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General NPI Number Information
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NPI Number | 1205381803
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Entity Type | Organization
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Legal Business Name | PAHOA PHARMACY LLC
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Dates
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Enumeration Date | 08/24/2016
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 15-2660 PAHOA VILLAGE RD
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City | PAHOA
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State | HI
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Zip | 96778-6720
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Country | US
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Telephone | 808-965-0601
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Fax | 808-965-0603
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Provider Business Mailing Address
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Address Line | PO BOX 11 15-2660 PAHOA VILLAGE ROAD SUITE 205
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City | PAHOA
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State | HI
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Zip | 96778-0011
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Country | US
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Telephone | 808-965-0601
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Fax | 808-965-0603
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Authorized Official
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Title or Position | OWNER, PIC, AO
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Name | ISMAIL ABDOLAHI
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Credential | RPH
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Telephone | 808-494-8960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY-909
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License Number State | HI
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