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General NPI Number Information
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NPI Number | 1083903264
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Entity Type | Organization
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Legal Business Name | WELLNESS PHARMACY STORE 2 INC
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Dates
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Enumeration Date | 03/29/2011
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 1120 MAUNAKEA ST STE 102
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City | HONOLULU
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State | HI
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Zip | 96817-5173
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Country | US
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Telephone | 808-550-2888
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Fax | 808-550-2889
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Provider Business Mailing Address
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Address Line | 100 N BERETANIA ST SUITE 148
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City | HONOLULU
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State | HI
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Zip | 96817-4712
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Country | US
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Telephone | 808-550-2888
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Fax | 808-550-2889
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Authorized Official
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Title or Position | OWNER
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Name | YIN PUN WONG
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Credential | PHARMD
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Telephone | 808-550-2888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY-801
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License Number State | HI
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