Provider Demographics
NPI:1174107254
Name:KAUAI REGION PHARMACY WEST
Entity type:Organization
Organization Name:KAUAI REGION PHARMACY WEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD RETAIL PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:VANDEN BUSSCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-338-2450
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:WAIMEA
Mailing Address - State:HI
Mailing Address - Zip Code:96796
Mailing Address - Country:US
Mailing Address - Phone:808-338-2450
Mailing Address - Fax:808-338-2451
Practice Address - Street 1:4643 WAIMEA CANYON DR.
Practice Address - Street 2:
Practice Address - City:WAIMEA
Practice Address - State:HI
Practice Address - Zip Code:96796
Practice Address - Country:US
Practice Address - Phone:808-338-2450
Practice Address - Fax:808-338-2451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy