Provider Demographics
NPI:1356994834
Name:LIHUE PHARMACY INC
Entity type:Organization
Organization Name:LIHUE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLICK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:808-246-9100
Mailing Address - Street 1:4491 KOLOPA ST STE A
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-2021
Mailing Address - Country:US
Mailing Address - Phone:808-246-9100
Mailing Address - Fax:808-246-9199
Practice Address - Street 1:4491 KOLOPA ST STE A
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-2021
Practice Address - Country:US
Practice Address - Phone:808-246-9100
Practice Address - Fax:808-246-9199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI546301Medicaid