Healthcare Provider Details

I. General information

NPI: 1114404712
Provider Name (Legal Business Name): KEITH ISAMU YOSHIZUKA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 CLUB DRIVE TOURO UNIVERSITY CALIFORNIA COLLEGE OF PHARMACY
VALLEJO CA
94592
US

IV. Provider business mailing address

1310 CLUB DRIVE TOURO UNIVERSITY CALIFORNIA COLLEGE OF PHARMACY
VALLEJO CA
94592
US

V. Phone/Fax

Practice location:
  • Phone: 707-638-5992
  • Fax: 707-638-5953
Mailing address:
  • Phone: 707-638-5992
  • Fax: 707-638-5953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: