Provider Demographics
NPI:1871767731
Name:PHARMAL LLC
Entity type:Organization
Organization Name:PHARMAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANG
Authorized Official - Prefix:
Authorized Official - First Name:BRYON
Authorized Official - Middle Name:
Authorized Official - Last Name:YOSHINO
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:808-840-5656
Mailing Address - Street 1:3375 KOAPAKA STRRET
Mailing Address - Street 2:STE G320
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819
Mailing Address - Country:US
Mailing Address - Phone:808-628-2870
Mailing Address - Fax:808-536-5180
Practice Address - Street 1:500 ALA MOANA BLVD
Practice Address - Street 2:TOWER 1- SUITE 302
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4920
Practice Address - Country:US
Practice Address - Phone:808-628-2870
Practice Address - Fax:808-536-5180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPHY7023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI620973Medicaid
1240097OtherNCPDP PROVIDER IDENTIFICATION NUMBER