Provider Demographics
NPI:1548579725
Name:MINA CORPORATION
Entity Type:Organization
Organization Name:MINA CORPORATION
Other - Org Name:MINA PHARMACY # 11
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT,CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ETINAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-738-4540
Mailing Address - Street 1:3375 KOAPAKA ST
Mailing Address - Street 2:F245
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1800
Mailing Address - Country:US
Mailing Address - Phone:808-738-4540
Mailing Address - Fax:808-690-9174
Practice Address - Street 1:1401 S BERETANIA ST STE 110
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1871
Practice Address - Country:US
Practice Address - Phone:808-955-6800
Practice Address - Fax:808-955-6877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPHY7873336C0003X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1266830006Medicare NSC
HI647240Medicaid
2126815OtherPK