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General NPI Number Information
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NPI Number | 1801192620
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Entity Type | Organization
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Legal Business Name | OUTRIGGER SHOPS, LTD.
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Dates
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Enumeration Date | 01/27/2011
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Last Update Date | 06/29/2012
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Provider Practice Location Address
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Address Line | 1922 KALAKAUA AVE
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City | HONOLULU
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State | HI
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Zip | 96815-1854
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Country | US
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Telephone | 808-942-1922
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Fax |
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Provider Business Mailing Address
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Address Line | 2330 KUHIO AVE MEZZANINE FLOOR
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City | HONOLULU
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State | HI
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Zip | 96815-2951
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Country | US
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Telephone | 808-923-2057
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Fax | 808-922-4393
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEVEN G NORSTROM
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Credential |
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Telephone | 808-923-2057
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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 | PHY795
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License Number State | HI
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