Provider Demographics
NPI:1952302770
Name:HO OLA LAHUI HAWAI I
Entity Type:Organization
Organization Name:HO OLA LAHUI HAWAI I
Other - Org Name:HO OLA LAHUI HAWAI I
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-240-0113
Mailing Address - Street 1:4491 RICE ST
Mailing Address - Street 2:STE 105A
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1343
Mailing Address - Country:US
Mailing Address - Phone:808-240-0200
Mailing Address - Fax:808-246-0721
Practice Address - Street 1:4491 RICE ST
Practice Address - Street 2:STE 105A
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1343
Practice Address - Country:US
Practice Address - Phone:808-240-0200
Practice Address - Fax:808-246-0721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
HIPHY6683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI788094Medicaid
2019428OtherPK
5555390001Medicare NSC