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General NPI Number Information
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NPI Number | 1275170656
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Entity Type | Individual
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Provider Name | STEPHANIE MEGUMI FUKUNAGA PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 12/05/2019
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Last Update Date | 12/05/2019
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Provider Practice Location Address
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Address Line | 25825 SOUTH VERMONT AVE NORTH HOSPITAL - PHARMACY ADMIN 1099
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City | HARBOR CITY
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State | CA
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Zip | 90710
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Country | US
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Telephone | 310-517-4079
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Fax |
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Provider Business Mailing Address
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Address Line | 729 35TH ST
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-3429
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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 | 81012
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License Number State | CA
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