Healthcare Provider Details

I. General information

NPI: 1710064456
Provider Name (Legal Business Name): SHARON SUN OBATAKE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 ROSECRANS AVE PHARMACY ADMINISTRATION
BELLFLOWER CA
90706-2246
US

IV. Provider business mailing address

21318 KENT AVE
TORRANCE CA
90503-5432
US

V. Phone/Fax

Practice location:
  • Phone: 562-461-6070
  • Fax:
Mailing address:
  • Phone: 310-316-3021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43552
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: