Healthcare Provider Details

I. General information

NPI: 1063457687
Provider Name (Legal Business Name): RICHARD T. YABUTA PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3139 W 179TH ST
TORRANCE CA
90504-4009
US

IV. Provider business mailing address

3139 W 179TH ST
TORRANCE CA
90504-4009
US

V. Phone/Fax

Practice location:
  • Phone: 310-324-2718
  • Fax:
Mailing address:
  • Phone: 310-324-2718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: