Healthcare Provider Details

I. General information

NPI: 1477224137
Provider Name (Legal Business Name): 5 MINUTE PHARMACY SBC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 12/20/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 NUUANU AVE # 1-A
HONOLULU HI
96817-5190
US

IV. Provider business mailing address

94-449 AKOKI ST STE 102
WAIPAHU HI
96797-2732
US

V. Phone/Fax

Practice location:
  • Phone: 808-809-6661
  • Fax: 808-845-5557
Mailing address:
  • Phone: 808-671-5511
  • Fax: 808-671-5522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. DEREK TENGAN
Title or Position: MANAGER
Credential: PHARM.D.
Phone: 808-671-5511