Provider Demographics
NPI:1447323100
Name:MALAMA COMPOUNDING PHARMACY
Entity type:Organization
Organization Name:MALAMA COMPOUNDING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:CHAI
Authorized Official - Middle Name:LOH
Authorized Official - Last Name:NEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-324-6888
Mailing Address - Street 1:81-6629 MAMALAHOA HWY
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-8130
Mailing Address - Country:US
Mailing Address - Phone:808-324-6888
Mailing Address - Fax:808-324-7888
Practice Address - Street 1:81-6629 MAMALAHOA HWY
Practice Address - Street 2:
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-8130
Practice Address - Country:US
Practice Address - Phone:808-324-6888
Practice Address - Fax:808-324-7888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPHY-142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty