Provider Demographics
NPI:1417055443
Name:QSI INC
Entity Type:Organization
Organization Name:QSI INC
Other - Org Name:TIMES PHARMACY #11
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:808-832-2855
Mailing Address - Street 1:1425 LILIHA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-3522
Mailing Address - Country:US
Mailing Address - Phone:808-522-5078
Mailing Address - Fax:808-522-5080
Practice Address - Street 1:1425 LILIHA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3522
Practice Address - Country:US
Practice Address - Phone:808-522-5078
Practice Address - Fax:808-522-5080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
HIPHY6283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2017900OtherPK
HI08389601Medicaid
HI1201160Medicaid
2017900OtherPK
HI1417055443OtherNPI