Provider Demographics
NPI:1962500991
Name:QSI INC
Entity Type:Organization
Organization Name:QSI INC
Other - Org Name:TIMES PHARMACY #4
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:808-832-2855
Mailing Address - Street 1:PO BOX 29960
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96820-2360
Mailing Address - Country:US
Mailing Address - Phone:808-832-8265
Mailing Address - Fax:808-832-8268
Practice Address - Street 1:45 934 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744
Practice Address - Country:US
Practice Address - Phone:808-233-4601
Practice Address - Fax:808-233-4627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
HIPHY6243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2018185OtherPK
HI1202186Medicaid
HI08473201Medicaid
HI1202186Medicaid
HI4448020007Medicare NSC