Provider Demographics
NPI:1134773344
Name:WAIMANALO HEALTH CENTER
Entity type:Organization
Organization Name:WAIMANALO HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STORE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-259-7948
Mailing Address - Street 1:41-1295 KALANIANAOLE HWY
Mailing Address - Street 2:
Mailing Address - City:WAIMANALO
Mailing Address - State:HI
Mailing Address - Zip Code:96795
Mailing Address - Country:US
Mailing Address - Phone:808-954-7102
Mailing Address - Fax:808-954-7179
Practice Address - Street 1:41-1295 KALANIANAOLE HWY
Practice Address - Street 2:
Practice Address - City:WAIMANALO
Practice Address - State:HI
Practice Address - Zip Code:96795
Practice Address - Country:US
Practice Address - Phone:808-954-7102
Practice Address - Fax:808-954-7179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-25
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy