Provider Demographics
NPI:1639247430
Name:CENTURY SQUARE PHARMACY
Entity Type:Organization
Organization Name:CENTURY SQUARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:UNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-536-0260
Mailing Address - Street 1:1188 BISHOP ST
Mailing Address - Street 2:STE 2303
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1188 BISHOP ST
Practice Address - Street 2:STE 2303
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3301
Practice Address - Country:US
Practice Address - Phone:808-536-0260
Practice Address - Fax:808-536-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPHY665333600000X
3336C0003X, 3336C0004X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336C0004XSuppliersPharmacyCompounding Pharmacy
Not Answered3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1239640OtherOTHER ID NUMBER-COMMERCIAL NUMBER
HI57341501Medicaid