Provider Demographics
NPI:1396862462
Name:LEEWARD OAHU PHARMACY INC
Entity Type:Organization
Organization Name:LEEWARD OAHU PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLIE
Authorized Official - Middle Name:YADAO
Authorized Official - Last Name:SONIDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-671-3911
Mailing Address - Street 1:94-837 WAIPAHU ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3320
Mailing Address - Country:US
Mailing Address - Phone:808-677-3911
Mailing Address - Fax:808-677-2720
Practice Address - Street 1:94-837 WAIPAHU ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3320
Practice Address - Country:US
Practice Address - Phone:808-677-3911
Practice Address - Fax:808-677-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPHY632333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI50723801Medicaid