Organization Active NPI

Waimanalo Pharmacy Inc

  • Community/Retail Pharmacy
  • Waimanalo, HI
National Provider Identifier
1477694339
Registry record updated Jun 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY-346 Issued in HI
Legal business name
WAIMANALO PHARMACY INC
Practice address
41 1610 Kalanianaole Hwy
Waimanalo, HI 96795
Phone
(808) 259-8488
Fax
(808) 259-0939
NPI assigned
Feb 12, 2007
Last updated
Jun 8, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2018

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

Authorized official

Name
Richard Chang
Title
Pharmacist
Phone
(808) 259-4888

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHY-346 HI Primary

Addresses

Primary practice location

41 1610 Kalanianaole Hwy
Waimanalo, HI 96795

Mailing address

41 1610 Kalanianaole Hwy
Waimanalo, HI 96795
Phone (808) 259-8488

Other identifiers 2

IdentifierTypeStateIssuer
01622401MedicaidHI
2017994OtherPK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170104000483 HI Part B Supplier - Mass Immunization (Roster Biller Only) 6709167893 Practice locations: Waimanalo, HI

National Provider Directory

National Provider Directory

Locations

41-1610 Kalanianaole Hwy
Waimanalo, HI 96795
Phone (808) 221-3109

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528416000000",
    "number": "1477694339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 1610 KALANIANAOLE HWY",
            "city": "WAIMANALO",
            "state": "HI",
            "postal_code": "96795",
            "telephone_number": "808-259-8488",
            "fax_number": "808-259-0939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 1610 KALANIANAOLE HWY",
            "city": "WAIMANALO",
            "state": "HI",
            "postal_code": "96795",
            "telephone_number": "808-259-8488",
            "fax_number": "808-259-0939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAIMANALO PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2018-06-08",
        "status": "A",
        "authorized_official_last_name": "CHANG",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "808-259-4888"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "HI",
            "license": "PHY-346",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01622401",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2017994",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waimanalo, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2018; 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.