Provider Demographics
NPI:1285812578
Name:BENUELLI BROTHERS INC
Entity type:Organization
Organization Name:BENUELLI BROTHERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAGDI
Authorized Official - Middle Name:
Authorized Official - Last Name:LATIF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-828-1844
Mailing Address - Street 1:2406 OKA STREET
Mailing Address - Street 2:STE 100
Mailing Address - City:KILAUEA
Mailing Address - State:HI
Mailing Address - Zip Code:96754
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 4280 KUHIO HWY
Practice Address - Street 2:
Practice Address - City:PRINCEVILLE
Practice Address - State:HI
Practice Address - Zip Code:96722
Practice Address - Country:US
Practice Address - Phone:808-826-1122
Practice Address - Fax:808-828-2866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
HIPHY6963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1240059OtherOTHER ID NUMBER