Healthcare Provider Details

I. General information

NPI: 1598913311
Provider Name (Legal Business Name): CRAIG KENNETH YABUMOTO PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N JACKSON AVE STE 103 SUITE #103
SAN JOSE CA
95116-1924
US

IV. Provider business mailing address

115 N JACKSON AVE STE 103 SUITE #103
SAN JOSE CA
95116-1924
US

V. Phone/Fax

Practice location:
  • Phone: 408-259-1000
  • Fax: 408-272-2342
Mailing address:
  • Phone: 408-259-1000
  • Fax: 408-272-2342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number44643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: