Provider Demographics
NPI:1922198845
Name:WILLIAM J FARLANDER INC
Entity Type:Organization
Organization Name:WILLIAM J FARLANDER INC
Other - Org Name:WESTSIDE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:808-335-5342
Mailing Address - Street 1:PO BOX 526
Mailing Address - Street 2:
Mailing Address - City:HANAPEPE
Mailing Address - State:HI
Mailing Address - Zip Code:96716-0526
Mailing Address - Country:US
Mailing Address - Phone:808-335-5342
Mailing Address - Fax:
Practice Address - Street 1:1 3845 KAUMUALII HWY
Practice Address - Street 2:
Practice Address - City:HANAPEPE
Practice Address - State:HI
Practice Address - Zip Code:96716
Practice Address - Country:US
Practice Address - Phone:808-335-5342
Practice Address - Fax:808-335-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336H0001X, 3336S0011X
HIPHY3023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2017895OtherPK
HI001028-01Medicaid