MEDICARE: MR. THEARATH ALAN WU PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	1966	HI

General Provider Information

NPI Number	:	1629602800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THEARATH ALAN WU PHARMD

Provider Business Mailing Address
First Line	:	2300 KANIO ST
Second Line	:
City	:	LIHUE
State	:	HI
Zip	:	96766-8801
Country	:	US
Telephone Number	:	808-635-5932
Fax Number	:

Provider Business Practice Location Address
First Line	:	3-2600 KAUMUALII HWY STE 2000
Second Line	:
City	:	LIHUE
State	:	HI
Zip	:	96766-2026
Country	:	US
Telephone Number	:	808-245-8871
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2020
Last Update Date	:	02/26/2020

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