Provider Demographics
NPI:1942903620
Name:5 MINUTE PHARMACY LLC
Entity Type:Organization
Organization Name:5 MINUTE PHARMACY LLC
Other - Org Name:5 MINUTE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:M
Authorized Official - Last Name:TENGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:808-677-5550
Mailing Address - Street 1:94-449 AKOKI ST STE 102
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-2732
Mailing Address - Country:US
Mailing Address - Phone:808-677-5550
Mailing Address - Fax:808-677-5553
Practice Address - Street 1:94-216 FARRINGTON HWY STE B1-102
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1922
Practice Address - Country:US
Practice Address - Phone:808-677-5550
Practice Address - Fax:808-677-5553
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:5 MINUTE PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-23
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI642951Medicaid