Provider Demographics
NPI:1306881891
Name:HAMAKUA FAMILY PHARMACY, INC.
Entity type:Organization
Organization Name:HAMAKUA FAMILY PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:808-937-6379
Mailing Address - Street 1:PO BOX 1363
Mailing Address - Street 2:
Mailing Address - City:HONOKAA
Mailing Address - State:HI
Mailing Address - Zip Code:96727-1363
Mailing Address - Country:US
Mailing Address - Phone:808-775-0825
Mailing Address - Fax:808-775-9786
Practice Address - Street 1:45-3551 MAMANE ST
Practice Address - Street 2:SUITE #4
Practice Address - City:HONOKAA
Practice Address - State:HI
Practice Address - Zip Code:96727
Practice Address - Country:US
Practice Address - Phone:808-775-0496
Practice Address - Fax:808-775-9786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIW40065112-01332B00000X
HIPHY-652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI558695Medicaid
HI558695Medicaid