Provider Demographics
NPI:1588759617
Name:APOTHECARY OF KAUAI, INC.
Entity type:Organization
Organization Name:APOTHECARY OF KAUAI, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MILES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:LAHR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, CDE
Authorized Official - Phone:808-822-1447
Mailing Address - Street 1:PO BOX 1113
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-1113
Mailing Address - Country:US
Mailing Address - Phone:808-822-1447
Mailing Address - Fax:808-823-0113
Practice Address - Street 1:1177 KUHIO HWY
Practice Address - Street 2:SUITE 113
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1113
Practice Address - Country:US
Practice Address - Phone:808-822-1447
Practice Address - Fax:808-823-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPHY-3443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1201829OtherNCPDP
HI001707-9OtherHMSA
HI001707-9OtherHMSA