Provider Demographics
NPI:1982035879
Name:NINETEEN FIFTY-ONE PARTNERS, INC.
Entity Type:Organization
Organization Name:NINETEEN FIFTY-ONE PARTNERS, INC.
Other - Org Name:MALAMA COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:LEI
Authorized Official - Last Name:MANWARRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-324-6888
Mailing Address - Street 1:PO BOX 75
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-0075
Mailing Address - Country:US
Mailing Address - Phone:808-324-6888
Mailing Address - Fax:808-324-7888
Practice Address - Street 1:74-5563 KUAKINI HWY
Practice Address - Street 2:SUITE 129
Practice Address - City:KAILUA-KONA
Practice Address - State:HI
Practice Address - Zip Code:96740
Practice Address - Country:US
Practice Address - Phone:808-324-6888
Practice Address - Fax:808-324-7888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPHY8453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143211OtherPK