Healthcare Provider Details

I. General information

NPI: 1407684889
Provider Name (Legal Business Name): DUANE TERUYUKI KOMAKI PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38600 MEDICAL CENTER DR
PALMDALE CA
93551-4483
US

IV. Provider business mailing address

1065 EAGLEMONT DR
WHITTIER CA
90601-1220
US

V. Phone/Fax

Practice location:
  • Phone: 661-382-5000
  • Fax:
Mailing address:
  • Phone: 626-422-1518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number37069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: