12D2226186 CLIA NUMBER - KTA KEAUHOU PHARMACY

Laboratory Demographics

CLIA Number: 12D2226186

Facility Name: KTA KEAUHOU PHARMACY

Facility Address:
78-6831 ALII DRIVE STE#101
KAILUA KONA, HI
ZIP 96740
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Facility Phone Number: 808 322-2511

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1518057017

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	12D2226186
LAB Type	Pharmacy
Facility Name	KTA KEAUHOU PHARMACY
Street	78-6831 ALII DRIVE STE#101
City	KAILUA KONA
State	HI
ZIP	96740
Phone	808 322-2511
CertificateType	4
CertificateEffectiveDate	5/26/2023
CertificateExpirationDate	5/25/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024