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General NPI Number Information
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NPI Number | 1255781076
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Entity Type | Individual
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Provider Name | JONATHAN KIYOSHI FUJIMOTO PHARM D.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 777 S HARBOR BLVD
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City | LA HABRA
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State | CA
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Zip | 90631-6882
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Country | US
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Telephone | 714-514-0485
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Fax | 401-652-0586
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Provider Business Mailing Address
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Address Line | 922 EVENING CANYON RD
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City | BREA
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State | CA
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Zip | 92821-2612
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Country | US
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Telephone | 714-514-0485
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Fax | 401-652-0586
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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 | 62795
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License Number State | CA
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