Provider Demographics
NPI:1578794905
Name:HONOLULU COMPOUNDING PHARMACY INC
Entity Type:Organization
Organization Name:HONOLULU COMPOUNDING PHARMACY INC
Other - Org Name:HONOLULU COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TAD
Authorized Official - Middle Name:
Authorized Official - Last Name:USHIJIMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-375-6520
Mailing Address - Street 1:2080 S KING ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-2226
Mailing Address - Country:US
Mailing Address - Phone:808-979-3400
Mailing Address - Fax:808-979-3401
Practice Address - Street 1:2080 S KING ST STE 101
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-2226
Practice Address - Country:US
Practice Address - Phone:808-979-3400
Practice Address - Fax:808-979-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
HIPHY 7733336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1240388OtherNCPDP PROVIDER IDENTIFICATION NUMBER