MEDICARE: PACIFIC HEALTH PHARMACY LLC

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	3336L0003X	Long Term Care Pharmacy
2	3336H0001X	Home Infusion Therapy Pharmacy
3	3336C0002X	Clinic Pharmacy
4	332B00000X	Durable Medical Equipment & Medical Supplies
5	3336C0003X	Community/Retail Pharmacy
6	3336M0002X	Mail Order Pharmacy
7	3336S0011X	Specialty Pharmacy
8	3336C0004X	Compounding Pharmacy	PHY681	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1239842	OTHER	OTHER ID NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1239842	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1699835827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC HEALTH PHARMACY LLC

Provider Business Mailing Address
First Line	:	2875 KOAPAKA ST
Second Line	:	STE B
City	:	HONOLULU
State	:	HI
Zip	:	96819-1921
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2875 KOAPAKA ST
Second Line	:	STE B
City	:	HONOLULU
State	:	HI
Zip	:	96819-1921
Country	:	US
Telephone Number	:	808-833-3414
Fax Number	:	808-833-3416

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	DARYLEANN HO
Credential	:
Telephone Number	:	808-833-3414

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/26/2007

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Directions to “PACIFIC HEALTH PHARMACY LLC ” Practice Location

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