Healthcare Provider Details

I. General information

NPI: 1477694339
Provider Name (Legal Business Name): WAIMANALO PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 1610 KALANIANAOLE HWY
WAIMANALO HI
96795
US

IV. Provider business mailing address

41 1610 KALANIANAOLE HWY
WAIMANALO HI
96795
US

V. Phone/Fax

Practice location:
  • Phone: 808-259-8488
  • Fax: 808-259-0939
Mailing address:
  • Phone: 808-259-8488
  • Fax: 808-259-0939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY-346
License Number StateHI

VIII. Authorized Official

Name: RICHARD CHANG
Title or Position: PHARMACIST
Credential:
Phone: 808-259-4888