Provider Demographics
NPI:1821188327
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: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 1:50 E PUAINAKO ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5242
Mailing Address - Country:US
Mailing Address - Phone:808-959-8700
Mailing Address - Fax:808-959-7559
Practice Address - Street 1:50 E PUAINAKO ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5242
Practice Address - Country:US
Practice Address - Phone:808-959-8700
Practice Address - Fax:808-959-7559
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
HIPHY4133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI08453401Medicaid
HI102639OtherMEDICARE MASS IMMUNIZ ROS
HI0838790001Medicare ID - Type Unspecified