Healthcare Provider Details

I. General information

NPI: 1194849679
Provider Name (Legal Business Name): PETER JEFFREY OGAWA PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7257 N FRESNO ST
FRESNO CA
93720-2950
US

IV. Provider business mailing address

680 E WOODHAVEN LN
FRESNO CA
93720-1286
US

V. Phone/Fax

Practice location:
  • Phone: 559-451-3632
  • Fax: 559-431-5827
Mailing address:
  • Phone: 559-434-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number39724
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: