Provider Demographics
NPI:1962770578
Name:5 MINUTE PHARMACY LTC KALIHI LLC
Entity type:Organization
Organization Name:5 MINUTE PHARMACY LTC KALIHI LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:TENGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-845-5558
Mailing Address - Street 1:1824 DILLINGHAM BLVD
Mailing Address - Street 2:SUITE #C
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4019
Mailing Address - Country:US
Mailing Address - Phone:808-845-5558
Mailing Address - Fax:808-845-5565
Practice Address - Street 1:1824 DILLINGHAM BLVD
Practice Address - Street 2:SUITE # C
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4019
Practice Address - Country:US
Practice Address - Phone:808-845-5558
Practice Address - Fax:808-845-5565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1240756OtherNCPDP PROVIDER IDENTIFICATION NUMBER