Healthcare Provider Details

I. General information

NPI: 1053308957
Provider Name (Legal Business Name): MUSUMI IWANAGA PHARM.D.,RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12737 GLENOAKS BLVD #27
SYLMAR CA
91342-4704
US

IV. Provider business mailing address

22603 LILAC CT
SANTA CLARITA CA
91390-4001
US

V. Phone/Fax

Practice location:
  • Phone: 818-362-6894
  • Fax:
Mailing address:
  • Phone: 661-296-3322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberBS5876252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: