Healthcare Provider Details

I. General information

NPI: 1073521126
Provider Name (Legal Business Name): IRENE YAMAGA MARSHALL PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IRENE YAMAGA TAMAI PHARM.D.

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD PHARMACY (119)
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

11301 WILSHIRE BLVD PHARMACY (119)
LOS ANGELES CA
90073-1003
US

V. Phone/Fax

Practice location:
  • Phone: 310-268-3408
  • Fax: 310-268-4959
Mailing address:
  • Phone: 310-268-3408
  • Fax: 310-268-4959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number38175
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: