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General NPI Number Information
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NPI Number | 1588050983
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Entity Type | Organization
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Legal Business Name | RAINBOW PHARMACY, LLC
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Dates
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Enumeration Date | 04/13/2015
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Last Update Date | 09/10/2015
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Provider Practice Location Address
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Address Line | 431 SEVENTH ST
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City | LANAI CITY
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State | HI
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Zip | 96763
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Country | US
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Telephone | 808-565-9332
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Fax | 808-565-9333
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Provider Business Mailing Address
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Address Line | PO BOX 631255
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City | LANAI CITY
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State | HI
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Zip | 96763-1255
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Country | US
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Telephone | 808-565-9333
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Fax | 808-565-9332
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Authorized Official
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Title or Position | OWNER/PHARMACIST-IN-CHARGE
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Name | KERT SHUSTER
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Credential | PHARM.D.
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Telephone | 808-879-9924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PHY885
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | PHY885
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License Number State | HI
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY885
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License Number State | HI
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