Healthcare Provider Details

I. General information

NPI: 1831400068
Provider Name (Legal Business Name): MARILYNN MATSUKO NAKAGAWA PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 E COLORADO BLVD
PASADENA CA
91106-2323
US

IV. Provider business mailing address

1563 INDIANA AVE
SOUTH PASADENA CA
91030-4111
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-5539
  • Fax:
Mailing address:
  • Phone: 323-255-8189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH25203
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: