Healthcare Provider Details

I. General information

NPI: 1053896761
Provider Name (Legal Business Name): DANIEL NORIYOSHI WATANABE PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 W 190TH ST
TORRANCE CA
90503-1004
US

IV. Provider business mailing address

PO BOX 4104
TORRANCE CA
90510-4104
US

V. Phone/Fax

Practice location:
  • Phone: 310-370-5607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4231
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number76992
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: