Provider Demographics
NPI:1821151440
Name:DUKE ANN CORPORATION
Entity Type:Organization
Organization Name:DUKE ANN CORPORATION
Other - Org Name:WINDWARD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND PIC
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYER
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:808-981-2055
Mailing Address - Street 1:2100 KANOELEHUA AVE
Mailing Address - Street 2:PUAINAKO TOWN CENTER B3
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-6500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 KANOELEHUA AVE
Practice Address - Street 2:PUAINAKO TOWN CENTER B3
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-6500
Practice Address - Country:US
Practice Address - Phone:808-981-2055
Practice Address - Fax:808-981-2155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPHY609333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1204142OtherOTHER ID NUMBER-COMMERCIAL NUMBER