Kailua Family Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY-856 Issued in HI

Legal business name

KAILUA FAMILY PHARMACY LLC

Practice address

1090 Keolu Dr Ste 112113
Kailua, HI 96734-3871

Phone

(808) 260-9894

Fax

(808) 260-9957

NPI assigned

Oct 21, 2014

Organization subpart

No

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

Authorized official

Name

Jake BlechtaNPI 1154980241

Title

President

Phone

(808) 397-1336

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• ElixRx Doing business as

Medicare fee-for-service enrollment

Enrolled in HI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jake Blechta, PHARMD

  • Pharmacist
  • Kailua, HI
  • NPI 1154980241
  NPD Authorized official

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

{
    "created_epoch": "1413849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454889600000",
    "number": "1740684604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1090 KEOLU DR",
            "address_2": "STE #112/113",
            "city": "KAILUA",
            "state": "HI",
            "postal_code": "967343871",
            "telephone_number": "808-260-9894",
            "fax_number": "808-260-9957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1090 KEOLU DR STE 112113",
            "city": "KAILUA",
            "state": "HI",
            "postal_code": "967343871",
            "telephone_number": "808-260-9894",
            "fax_number": "808-260-9957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAILUA FAMILY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-21",
        "last_updated": "2016-02-08",
        "status": "A",
        "authorized_official_last_name": "BLECHTA",
        "authorized_official_first_name": "JAKE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "808-397-1336"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "HI",
            "license": "PHY-856",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2148405",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ElixRx",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kailua Dermatology Associates LTD
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• Kailua Ear, Nose and Throat LLC
• Kailua Early Intervention Program
• Kailua Family Dental LLC
• Kailua Integrative Medicine LLC
• Kailua Pediatrics LLC
• Kailua Physical Therapy Clinic, Inc
• Kailua Physical Therapy Clinic, Inc
• Kailua Physical Therapy Clinic, Inc

• All providers in Kailua, HI
• Community/Retail Pharmacy in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.