Provider Demographics
NPI:1104573088
Name:5 MINUTE PHARMACY LTC LLC
Entity type:Organization
Organization Name:5 MINUTE PHARMACY LTC LLC
Other - Org Name:
Other - Org Type:
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:PHARMD
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?:Yes
Parent Organization LBN:5 MINUTE PHARMACY LTC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI688690Medicaid