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General NPI Number Information
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NPI Number | 1528868379
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Entity Type | Organization
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Legal Business Name | SUSTAIN HAWAII
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 41-1029 KALANIANAOLE HWY
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City | WAIMANALO
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State | HI
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Zip | 96795-1641
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Country | US
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Telephone | 808-721-2174
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Fax |
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Provider Business Mailing Address
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Address Line | 41-902 KAULUKANU ST
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City | WAIMANALO
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State | HI
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Zip | 96795-1430
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDING DIRECTOR
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Name | KEVIN VACCARELLO
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Credential |
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Telephone | 808-739-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335G00000X
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Taxonomy Name | Medical Foods Supplier
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License Number |
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License Number State |
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