Basic Information
| Provider Information | |||||||||
| NPI: | 1821689746 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FAUST | ||||||||
| FirstName: | GLENN | ||||||||
| MiddleName: | ANDREW | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16-192 PILI MUA ST | ||||||||
| Address2: | |||||||||
| City: | KEAAU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967498134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083333600 | ||||||||
| FaxNumber: | 8089300440 | ||||||||
| Practice Location | |||||||||
| Address1: | 16-192 PILI MUA ST | ||||||||
| Address2: | |||||||||
| City: | KEAAU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967498134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083333600 | ||||||||
| FaxNumber: | 8089300440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2021 | ||||||||
| LastUpdateDate: | 02/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 2389 | HI | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.