Provider Demographics
NPI:1821074972
Name:LIHUE PHARMACY INC
Entity Type:Organization
Organization Name:LIHUE PHARMACY INC
Other - Org Name:LIHUE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLICK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:808-246-9100
Mailing Address - Street 1:4491 KOLOPA ST STE A
Mailing Address - Street 2:SUITE A
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-2021
Mailing Address - Country:US
Mailing Address - Phone:808-246-9100
Mailing Address - Fax:808-246-9199
Practice Address - Street 1:4491 KOLOPA ST STE A
Practice Address - Street 2:SUITE A
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-2021
Practice Address - Country:US
Practice Address - Phone:808-246-9100
Practice Address - Fax:808-246-9199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X, 3336C0004X, 3336L0003X
HIPHY647333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2019371OtherPK
HI546301Medicaid
5538600001Medicare NSC