Provider Demographics
NPI:1629602800
Name:WU, THEARATH ALAN (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:THEARATH
Middle Name:ALAN
Last Name:WU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 KANIO ST
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-8801
Mailing Address - Country:US
Mailing Address - Phone:808-635-5932
Mailing Address - Fax:
Practice Address - Street 1:3-2600 KAUMUALII HWY STE 2000
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-2026
Practice Address - Country:US
Practice Address - Phone:808-245-8871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1966183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist