Wailea Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY-855 Issued in HI

Legal business name

WAILEA PHARMACY LLC

Doing business as

Wailea Pharmacy

Practice address

34 Wailea Gateway PL Ste A103
Wailea, HI 96753-6525

Phone

(808) 879-0123

Fax

(808) 879-2345

NPI assigned

Jul 21, 2014

Last updated

Jan 19, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Farah Mikhail

Title

Member

Phone

(808) 927-3426

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Wailea Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1405900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453161600000",
    "number": "1285041319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 WAILEA GATEWAY PL # A103",
            "city": "WAILEA",
            "state": "HI",
            "postal_code": "967536525",
            "telephone_number": "808-879-0123",
            "fax_number": "808-879-2345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 WAILEA GATEWAY PL STE A103",
            "city": "WAILEA",
            "state": "HI",
            "postal_code": "967536525",
            "telephone_number": "808-879-0123",
            "fax_number": "808-879-2345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAILEA PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-21",
        "last_updated": "2016-01-19",
        "status": "A",
        "authorized_official_last_name": "MIKHAIL",
        "authorized_official_first_name": "FARAH",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "808-927-3426"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "HI",
            "license": "PHY-855",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2147004",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wailea Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Wailea, HI
• Providers in Wailea, HI by specialty
• Community/Retail Pharmacy in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2016; 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.