Healthcare Provider Details

I. General information

NPI: 1477636942
Provider Name (Legal Business Name): JENNIFER KAY TAKIGUCHI PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25825 SOUTH VERMONT AVENUE
HARBOR CITY CA
90710
US

IV. Provider business mailing address

1 SPRINGFLOWER
IRVINE CA
92614-7588
US

V. Phone/Fax

Practice location:
  • Phone: 310-517-2364
  • Fax:
Mailing address:
  • Phone: 949-653-1250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRPH 46461
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: