Provider Demographics
NPI:1235475138
Name:LEEWARD DRUG LIMITED DBA WAIPAHU DRUG EXPRESS
Entity type:Organization
Organization Name:LEEWARD DRUG LIMITED DBA WAIPAHU DRUG EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-677-0794
Mailing Address - Street 1:94-748 HIKIMOE ST STE A
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3350
Mailing Address - Country:US
Mailing Address - Phone:808-677-0794
Mailing Address - Fax:808-677-1199
Practice Address - Street 1:94-837 WAIPAHU ST. 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797
Practice Address - Country:US
Practice Address - Phone:808-677-9611
Practice Address - Fax:808-671-5961
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEEWARD DRUG LIMITED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy