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General NPI Number Information
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NPI Number | 1982115176
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Entity Type | Individual
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Provider Name | COREY MICHAEL NAKATA RPH
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Gender | Male
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Dates
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Enumeration Date | 10/16/2017
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Last Update Date | 08/12/2021
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Provider Practice Location Address
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Address Line | 420 W ACACIA ST STE 4
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City | STOCKTON
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State | CA
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Zip | 95203-2441
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Country | US
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Telephone | 209-466-2954
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Fax | 209-466-1558
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Provider Business Mailing Address
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Address Line | 942 COBBLE SHORES DRIVE
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City | SACRAMENTO
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State | CA
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Zip | 95831
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Country | US
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Telephone | 916-215-4623
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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 | 77592
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License Number State | CA
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