NPIMap

Organization Active NPI

Valley Isle Pharmacy

  • Community/Retail Pharmacy
  • Wailuku, HI
National Provider Identifier
1861448979
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
379 Issued in HI
Legal business name
VALLEY ISLE PHARMACY
Practice address
99 S Market St
Wailuku, HI 96793-2200
Phone
(808) 242-7095
Fax
(808) 244-9747
NPI assigned
May 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Clint M. Komoda, R.PH.NPI 1720355985
Title
Manager
Phone
(808) 242-7095

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 379 HI Primary

Addresses

Primary practice location

99 S Market St
Wailuku, HI 96793-2200

Mailing address

99 S Market St
Wailuku, HI 96793-2200
Phone (808) 242-7095

Other identifiers 1

IdentifierTypeStateIssuer
08323601MedicaidHI

Other names 1

  • wailuku town pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Valley Isle Pharmacy3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

99 S Market St
Wailuku, HI 96793
Phone (808) 242-7095

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861448979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 S MARKET ST",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932200",
            "telephone_number": "808-242-7095",
            "fax_number": "808-244-9747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 S MARKET ST",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932200",
            "telephone_number": "808-242-7095",
            "fax_number": "808-244-9747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY ISLE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KOMODA",
        "authorized_official_first_name": "CLINT",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "808-242-7095",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "HI",
            "license": "379",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08323601",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "wailuku town pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wailuku, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.