Healthcare Provider Details

I. General information

NPI: 1093454902
Provider Name (Legal Business Name): DANIEL KUDO PHARMD APH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 N LAUREL AVE
UPLAND CA
91786-2765
US

IV. Provider business mailing address

1404 N LAUREL AVE
UPLAND CA
91786-2765
US

V. Phone/Fax

Practice location:
  • Phone: 951-317-0571
  • Fax:
Mailing address:
  • Phone: 951-317-0571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberRPH029611
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: