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General NPI Number Information
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NPI Number | 1104294792
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Entity Type | Individual
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Provider Name | STEPHANIE GREGORIO ICHIKAWA PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/13/2015
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 11301 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90073-1003
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Country | US
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Telephone | 310-478-3711
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 515
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City | REDONDO BEACH
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State | CA
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Zip | 90277-0515
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 73551
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH-3879
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License Number State | HI
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