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General NPI Number Information
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NPI Number | 1861448979
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Entity Type | Organization
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Legal Business Name | VALLEY ISLE PHARMACY
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 99 S MARKET ST
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City | WAILUKU
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State | HI
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Zip | 96793-2200
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Country | US
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Telephone | 808-242-7095
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Fax | 808-244-9747
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Provider Business Mailing Address
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Address Line | 99 S MARKET ST
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City | WAILUKU
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State | HI
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Zip | 96793-2200
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Country | US
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Telephone | 808-242-7095
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Fax | 808-244-9747
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Authorized Official
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Title or Position | MANAGER
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Name | MR. CLINT M. KOMODA
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Credential | R.PH.
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Telephone | 808-242-7095
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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 | 379
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License Number State | HI
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