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General NPI Number Information
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NPI Number | 1659760734
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Entity Type | Organization
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Legal Business Name | MINA PHARMACY LLC
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 01/13/2015
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Provider Practice Location Address
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Address Line | 3375 KOAPAKA ST SUITE F245
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City | HONOLULU
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State | HI
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Zip | 96819-1800
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Country | US
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Telephone | 808-222-9252
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Fax | 808-356-3392
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Provider Business Mailing Address
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Address Line | 275 W KAAHUMANU AVE SUITE# 1C01A
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City | KAHULUI
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State | HI
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Zip | 96732-1629
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Country | US
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Telephone | 808-856-3070
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Fax |
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Authorized Official
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Title or Position | PRESIDENT,CEO
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Name | MR. ADEL ETINAS
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Credential | RPH
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Telephone | 808-222-9252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | PHY-813
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License Number State | HI
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