Healthcare Provider Details

I. General information

NPI: 1245724244
Provider Name (Legal Business Name): STEPHANIE MAYUMI SEKIMURA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 WILSHIRE BLVD
LOS ANGELES CA
90017-1901
US

IV. Provider business mailing address

408 W MAIN ST UNIT 1B
ALHAMBRA CA
91801-3449
US

V. Phone/Fax

Practice location:
  • Phone: 213-977-2121
  • Fax:
Mailing address:
  • Phone: 808-428-1962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number77464
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: