Individual provider Active NPI

Matthew Tanaid, RPH

  • Pharmacist
  • Ewa Beach, HI
National Provider Identifier
1124693296
Registry record updated May 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PH-4132 Issued in HI
Practice address
91-1081 Keaunui Dr
Ewa Beach, HI 96706-6351
Phone
(808) 683-1166
NPI assigned
May 21, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PH-4132 HI Primary

Addresses

Primary practice location

91-1081 Keaunui Dr
Ewa Beach, HI 96706-6351

Mailing address

91-1081 Keaunui Dr
Ewa Beach, HI 96706-6351

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
PH-4132HIMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co CurrentSince May 1, 2022 Accepting new patients
Walgreen Co PastSince May 25, 2021 Accepting new patients

Locations

91-1081 Keaunui Dr
Ewa Beach, HI 96706
Phone (808) 683-1166

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1621555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621555200000",
    "number": "1124693296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "91-1081 KEAUNUI DR",
            "city": "EWA BEACH",
            "state": "HI",
            "postal_code": "967066351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91-1081 KEAUNUI DR",
            "city": "EWA BEACH",
            "state": "HI",
            "postal_code": "967066351",
            "telephone_number": "808-683-1166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANAID",
        "first_name": "MATTHEW",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-21",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "HI",
            "license": "PH-4132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ewa Beach, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.