Healthcare Provider Details

I. General information

NPI: 1790391621
Provider Name (Legal Business Name): ALYSSA CATHERINE NAKAGUCHI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8762
US

IV. Provider business mailing address

790 OVERSTONE AVE
MADERA CA
93636-8031
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-8257
  • Fax: 559-353-5515
Mailing address:
  • Phone: 559-430-6350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number82607
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: