Basic Information
Provider Information
NPI: 1326356437
EntityType: 2
ReplacementNPI:  
OrganizationName: WAIKIKI HEALTH CENTER PHARMACY
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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Mailing Information
Address1: 277 OHUA AVE
Address2:  
City: HONOLULU
State: HI
PostalCode: 968156612
CountryCode: US
TelephoneNumber: 8089224787
FaxNumber: 8089224950
Practice Location
Address1: 277 OHUA AVE
Address2:  
City: HONOLULU
State: HI
PostalCode: 968156612
CountryCode: US
TelephoneNumber: 8089224787
FaxNumber: 8089224950
Other Information
ProviderEnumerationDate: 09/23/2010
LastUpdateDate: 11/14/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: BECKHAM
AuthorizedOfficialFirstName: SHEILA
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 8087919302
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
3336C0002XPHY-789HIY SuppliersPharmacyClinic Pharmacy

No ID Information.


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