Active NPI
Waimanalo Pharmacy Inc
- Community/Retail Pharmacy
- Waimanalo, HI
National Provider Identifier
1477694339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- PHY-346
- 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, 2018
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01622401 | Medicaid | HI | |
| 2017994 | Other | PK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in HI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170104000483 | HI | Part B Supplier - Mass Immunization (Roster Biller Only) | 6709167893 | Practice locations: Waimanalo, HI |
National Provider Directory
National Provider DirectoryLocations
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.
-
- Pharmacist
- Waimanalo, HI
- NPI 1730781840
-
- Pharmacist
- Waimanalo, HI
- NPI 1558963694
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.