Provider Demographics
NPI:1962846063
Name:PUNA PLANTATION HAWAII, LTD
Entity Type:Organization
Organization Name:PUNA PLANTATION HAWAII, LTD
Other - Org Name:WAIKOLOA VILLAGE MARKET 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 1:68-3916 PANIOLO AVE
Mailing Address - Street 2:
Mailing Address - City:WAIKOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96738
Mailing Address - Country:US
Mailing Address - Phone:808-883-8434
Mailing Address - Fax:
Practice Address - Street 1:68-3916 PANIOLO AVE
Practice Address - Street 2:
Practice Address - City:WAIKOLOA
Practice Address - State:HI
Practice Address - Zip Code:96738
Practice Address - Country:US
Practice Address - Phone:808-883-8434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPHY8343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI766842Medicaid