Provider Demographics
NPI:1356835730
Name:PRINCEVILLE PHARMACY AND HEALTH EMPORIUM LLC
Entity Type:Organization
Organization Name:PRINCEVILLE PHARMACY AND HEALTH EMPORIUM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHEREE
Authorized Official - Middle Name:
Authorized Official - Last Name:LATIF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-651-7593
Mailing Address - Street 1:4488 HANALEI PLANTATION ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PRINCEVILLE
Mailing Address - State:HI
Mailing Address - Zip Code:96722
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4488 HANALEI PLANTATION ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:PRINCEVILLE
Practice Address - State:HI
Practice Address - Zip Code:96722
Practice Address - Country:US
Practice Address - Phone:808-826-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPHY9213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy