# MEDIPHARM PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MEDIPHARM PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912024209
- **Authorized official:** SCOTT KIM (PHRM)
- **Authorized official phone:** (808) 523-7088

## Contact information

- **Practice address:** 197 SAND ISLAND ACCESS RD STE 208, HONOLULU, HI 96819-4901
- **Practice address phone:** (808) 744-9080
- **Practice address fax:** (808) 744-9079
- **Mailing address:** PO BOX 38029, HONOLULU, HI 96837-1029
- **Mailing address phone:** (808) 791-6077
- **Mailing address fax:** (808) 791-6076

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | PHY689 | HI | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 03/23/2007
- **Last updated:** 08/15/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1239929 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |
| 05 | — | 592495 | — | HI |