Provider Demographics
NPI:1518057017
Name:PUNA PLANTATION HAWAII, LTD.
Entity Type:Organization
Organization Name:PUNA PLANTATION HAWAII, LTD.
Other - Org Name:KTA KEAUHOU PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:B
Authorized Official - Last Name:TANIGUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-989-5466
Mailing Address - Street 1:78-6831 ALII DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2495
Mailing Address - Country:US
Mailing Address - Phone:808-322-2511
Mailing Address - Fax:808-322-1832
Practice Address - Street 1:78-6831 ALII DR
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2495
Practice Address - Country:US
Practice Address - Phone:808-322-2511
Practice Address - Fax:808-322-1832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPHY3493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI102639OtherMEDICARE MASS IMMUNIZ ROS
HI08387401Medicaid
HI08387401Medicaid