Provider Demographics
NPI:1720033236
Name:L KRENK, INC.
Entity Type:Organization
Organization Name:L KRENK, INC.
Other - Org Name:MAUI CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRENK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:808-877-6222
Mailing Address - Street 1:22 HANA HWY STE B
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2105
Mailing Address - Country:US
Mailing Address - Phone:808-877-6222
Mailing Address - Fax:808-877-2430
Practice Address - Street 1:22 HANA HWY STE B
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2105
Practice Address - Country:US
Practice Address - Phone:808-877-6222
Practice Address - Fax:808-877-2430
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:L KRENK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-23
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI08193801Medicaid
HI609431OtherHMSA
HI1175340001Medicare NSC
HI609431OtherHMSA