Provider Demographics
NPI:1033412895
Name:KAPA'A PHARMACY, LLC
Entity Type:Organization
Organization Name:KAPA'A PHARMACY, LLC
Other - Org Name:LIHUE CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-246-9100
Mailing Address - Street 1:4490 KOLOPA ST STE B
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-2027
Mailing Address - Country:US
Mailing Address - Phone:808-246-6900
Mailing Address - Fax:808-246-6906
Practice Address - Street 1:3216 ELUA ST
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1213
Practice Address - Country:US
Practice Address - Phone:808-246-6900
Practice Address - Fax:808-246-6906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPHY 7933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy