Basic Information
| Provider Information | |||||||||
| NPI: | 1255988119 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THAI | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | NGO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 91-1044 KAI LOLI ST | ||||||||
| Address2: | |||||||||
| City: | EWA BEACH | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967066270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085579034 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 95-1249 MEHEULA PKWY STE D | ||||||||
| Address2: | |||||||||
| City: | MILILANI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967891779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086255222 | ||||||||
| FaxNumber: | 8086255950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2019 | ||||||||
| LastUpdateDate: | 08/24/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 4045 | HI | Y | 193400000X SINGLE SPECIALTY GROUP | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | PH4045 | 01 | HI | HAWAII BOARD OF PHARMACY | OTHER | PH4045 | 05 | HI | MEDICAID |