# MEDIPHARM PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Medipharm Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013305457
- **Authorized official:** SCOTT DAHLEM (OFFICE MANAGER)
- **Authorized official phone:** (808) 523-7088

## Contact information

- **Practice address:** 891 ULULANI ST STE 113, HILO, HI 96720-3982
- **Practice address phone:** (808) 969-9163
- **Practice address fax:** (808) 969-9263
- **Mailing address:** PO BOX 38029, HONOLULU, HI 96837-1029
- **Mailing address phone:** (808) 744-9080
- **Mailing address fax:** (808) 744-9079

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHY870 | HI | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 01/08/2015
- **Last updated:** 10/11/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2149431 | PK | — |
| 05 | — | 539116 | — | HI |