Provider Demographics
NPI:1336427509
Name:5 MINUTE PHARMACY LTC LLC
Entity Type:Organization
Organization Name:5 MINUTE PHARMACY LTC LLC
Other - Org Name:5 MINUTE PHARMACY LONG TERM CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:TENGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-671-5511
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:808-671-5511
Mailing Address - Fax:808-671-5522
Practice Address - Street 1:94-449 AKOKI ST STE 102
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2732
Practice Address - Country:US
Practice Address - Phone:808-671-5511
Practice Address - Fax:808-671-5522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
HIPHY-8053336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2131191OtherPK
HI688690Medicaid