# WAILEA PHARMACY LLC

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

## Provider details

- **NPI number:** 1285041319
- **Authorized official:** FARAH MIKHAIL (MEMBER)
- **Authorized official phone:** (808) 927-3426

## Contact information

- **Practice address:** 34 WAILEA GATEWAY PL STE A103, WAILEA, HI 96753-6525
- **Practice address phone:** (808) 879-0123
- **Practice address fax:** (808) 879-2345
- **Mailing address:** 34 WAILEA GATEWAY PL \# A103, WAILEA, HI 96753-6525
- **Mailing address phone:** (808) 879-0123
- **Mailing address fax:** (808) 879-2345

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | PHY-855 | HI | Yes |

## Other

- **Enumeration date:** 07/21/2014
- **Last updated:** 01/19/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2147004 | PK | — |