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General NPI Number Information
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NPI Number | 1205413101
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Entity Type | Organization
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Legal Business Name | LANAI COMMUNITY HEALTH CENTER
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Dates
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Enumeration Date | 03/26/2021
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Last Update Date | 03/26/2021
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Provider Practice Location Address
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Address Line | 333 SIXTH STREET
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City | LANAI CITY
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State | HI
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Zip | 96763-0142
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Country | US
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Telephone | 808-565-6919
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Fax | 808-565-9111
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Provider Business Mailing Address
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Address Line | PO BOX 630142
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City | LANAI CITY
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State | HI
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Zip | 96763-0142
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Country | US
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Telephone | 808-565-6919
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DIANA M V SHAW
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Credential | PHD
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Telephone | 808-565-6919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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