MEDICARE: NAN KULI KAI PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PHY499	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	B80057	OTHER		HMSA

General Provider Information

NPI Number	:	1710066303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAN KULI KAI PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 385001
Second Line	:
City	:	WAIKOLOA
State	:	HI
Zip	:	96738-5001
Country	:	US
Telephone Number	:	808-883-8484
Fax Number	:	808-883-8871

Provider Business Practice Location Address
First Line	:	68 1845 WAIKOLOA ROAD
Second Line	:	#113
City	:	WAIKOLOA
State	:	HI
Zip	:	96738-5001
Country	:	US
Telephone Number	:	808-883-8484
Fax Number	:	808-883-8871

Authorized Official
Title or Position	:	CORP PRES V PRES
Name	:	MRS. BONNIE G PREBULA
Credential	:	RPH
Telephone Number	:	808-965-5629

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	07/21/2008

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Directions to “NAN KULI KAI PHARMACY INC ” Practice Location

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