Provider Demographics
NPI:1790081685
Name:WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED
Entity Type:Organization
Organization Name:WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED
Other - Org Name:KAPOLEI PROFESSIONAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:Z
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CMPE
Authorized Official - Phone:808-697-3300
Mailing Address - Street 1:599 FARRINGTON HWY
Mailing Address - Street 2:BLDG #1, UNIT 100
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2028
Mailing Address - Country:US
Mailing Address - Phone:808-697-3784
Mailing Address - Fax:808-687-3835
Practice Address - Street 1:599 FARRINGTON HWY
Practice Address - Street 2:BLDG #1, UNIT 100
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2028
Practice Address - Country:US
Practice Address - Phone:808-697-3784
Practice Address - Fax:808-687-3835
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
HIPHY-7913336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1240617OtherNCPDP
HIE10100OtherSTATE NARCOTICS
HI64995701Medicaid
FW2402357OtherDEA
HI64995701Medicaid