Healthcare Provider Details

I. General information

NPI: 1851485833
Provider Name (Legal Business Name): COLLEEN MIKI KOBASHIGAWA PHARM. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 KIELY BLVD
SANTA CLARA CA
95051-5329
US

IV. Provider business mailing address

1430 RAVENSWOOD DR
LOS ALTOS CA
94024-5849
US

V. Phone/Fax

Practice location:
  • Phone: 408-236-5225
  • Fax:
Mailing address:
  • Phone: 650-967-6554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 41810
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: