Provider Demographics
NPI:1275830069
Name:3 SISTERS INCONTINENT SUPPLIES
Entity Type:Organization
Organization Name:3 SISTERS INCONTINENT SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RO-AN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-429-4557
Mailing Address - Street 1:94-109 POLUHI WAY
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-5806
Mailing Address - Country:US
Mailing Address - Phone:808-429-4557
Mailing Address - Fax:808-888-4910
Practice Address - Street 1:94-109 POLUHI WAY
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-5806
Practice Address - Country:US
Practice Address - Phone:808-429-4557
Practice Address - Fax:808-888-4910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIW1322715301332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI=========OtherMEDICARE/MEDICAID