Provider Demographics
NPI:1073882387
Name:CENTRAL FILL PHARMACY
Entity Type:Organization
Organization Name:CENTRAL FILL PHARMACY
Other - Org Name:MINA PHARMACY #16
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-738-4540
Mailing Address - Street 1:3375 KOAPAKA ST STE F245
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1881
Mailing Address - Country:US
Mailing Address - Phone:808-738-4540
Mailing Address - Fax:808-690-9163
Practice Address - Street 1:3375 KOAPAKA ST STE F245
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1881
Practice Address - Country:US
Practice Address - Phone:808-738-4540
Practice Address - Fax:808-690-9163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
HI8043336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1240744OtherNCPDP PROVIDER IDENTIFICATION NUMBER