Provider Demographics
NPI:1134283021
Name:FOODLAND SUPERMARKET LTD
Entity Type:Organization
Organization Name:FOODLAND SUPERMARKET LTD
Other - Org Name:FOODLAND MEDICINE CABINET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:KAWANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-735-3260
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:808-735-7202
Mailing Address - Fax:808-732-4691
Practice Address - Street 1:55 PUKALANI ST
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8544
Practice Address - Country:US
Practice Address - Phone:808-572-8266
Practice Address - Fax:808-572-0144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
HI5543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2018851OtherPK
HI52685801Medicaid