Provider Demographics
NPI:1093860959
Name:FOODLAND SUPERMARKET LTD
Entity Type:Organization
Organization Name:FOODLAND SUPERMARKET LTD
Other - Org Name:FOODLAND PHARMACY #38
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-735-7202
Mailing Address - Street 1:3536 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-2453
Mailing Address - Country:US
Mailing Address - Phone:808-732-0791
Mailing Address - Fax:808-735-7275
Practice Address - Street 1:67 1185 MAMALAHOA HWY
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743
Practice Address - Country:US
Practice Address - Phone:808-885-2075
Practice Address - Fax:808-885-2061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
HIPHY6333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI52687401Medicaid
2019359OtherPK
HIBO1384Medicaid