MEDICARE: MR. KEITH HIROSHI IMAZUMI RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	32634	CA

General Provider Information

NPI Number	:	1053502443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEITH HIROSHI IMAZUMI RPH

Provider Business Mailing Address
First Line	:	2504 ASCOT WAY
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-1815
Country	:	US
Telephone Number	:	510-414-0847
Fax Number	:

Provider Business Practice Location Address
First Line	:	2504 ASCOT WAY
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-1815
Country	:	US
Telephone Number	:	510-414-0847
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2007
Last Update Date	:	07/23/2020

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