Healthcare Provider Details

I. General information

NPI: 1699164368
Provider Name (Legal Business Name): KAY WATANABE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2015
Last Update Date: 01/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 W SHAW AVE
CLOVIS CA
93612-3692
US

IV. Provider business mailing address

7830 E FLORADORA AVE
FRESNO CA
93737-9532
US

V. Phone/Fax

Practice location:
  • Phone: 559-297-4391
  • Fax:
Mailing address:
  • Phone: 559-255-2309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH27120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: