Provider Demographics
NPI:1609028653
Name:PUNA PLANTATION HAWAII LTD
Entity Type:Organization
Organization Name:PUNA PLANTATION HAWAII LTD
Other - Org Name:KTA PUAINAKO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:OKAMURA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:808-959-4575
Mailing Address - Street 1:50 E PUAINAKO ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5243
Mailing Address - Country:US
Mailing Address - Phone:808-959-8700
Mailing Address - Fax:
Practice Address - Street 1:50 E PUAINAKO ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5243
Practice Address - Country:US
Practice Address - Phone:808-959-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH413333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI08453401Medicaid
HIH102639OtherMEDICARE MASS IMMUNIZER
HI55229101OtherMEDICAID WAIVER
HIH102639OtherMEDICARE MASS IMMUNIZER