NPIMap

Organization Active NPI

Queens Development Corporation & Subsidiaries

  • Pharmacy
  • Honolulu, HI
National Provider Identifier
1003984246
Registry record updated Jul 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
PHY679 Issued in HI
Legal business name
QUEENS DEVELOPMENT CORPORATION & SUBSIDIARIES
Practice address
550 S Beretania St
Ste 102
Honolulu, HI 96813-2414
Phone
(808) 691-8925
Fax
(808) 691-8926
NPI assigned
Dec 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gavin Sanjume, PHARMD
Title
Dir, Retail & Contrct Phcy
Phone
(808) 691-4342

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X PHY679 HI Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

550 S Beretania St
Ste 102
Honolulu, HI 96813-2414

Mailing address

550 S Beretania St
Ste 102
Honolulu, HI 96813-2414
Phone (808) 691-8925

Other identifiers 2

IdentifierTypeStateIssuer
614041MedicaidHI
2019448OtherPK

Other names 1

  • QUEENS POB III PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20111230000633 HI DME Supplier - Pharmacy 7810912292 Practice locations: Honolulu, HI
O20190711003591 HI Part B Supplier - Pharmacy 7810912292 3 other NPIs on this enrollment
Practice locations: Ewa Beach, HI; Honolulu, HI
O20201231001736 HI Part B Supplier - Mass Immunization (Roster Biller Only) 7810912292 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ewa Beach, HI; Honolulu, HI

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Queen'S Development Corporation and Subsidiaries17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689811200000",
    "number": "1003984246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 S BERETANIA ST",
            "address_2": "STE 102",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968132414",
            "telephone_number": "808-691-8925",
            "fax_number": "808-691-8926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 S BERETANIA ST",
            "address_2": "STE 102",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968132414",
            "telephone_number": "808-691-8925",
            "fax_number": "808-691-8926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUEENS DEVELOPMENT CORPORATION & SUBSIDIARIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-18",
        "status": "A",
        "authorized_official_last_name": "SANJUME",
        "authorized_official_first_name": "GAVIN",
        "authorized_official_title_or_position": "DIR, RETAIL & CONTRCT PHCY",
        "authorized_official_telephone_number": "808-691-4342",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "HI",
            "license": "PHY679",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "614041",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2019448",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "QUEENS POB III PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "QUEENS POB III PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Honolulu, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.