MEDICARE: EMILY ISHIKAWA PHARM.D.

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	1835G0303X	Geriatric Pharmacist	52929	CA

General Provider Information

NPI Number	:	1164421889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ISHIKAWA PHARM.D.

Provider Business Mailing Address
First Line	:	11201 BENTON ST / 119
Second Line	:
City	:	LOMA LINDA
State	:	CA
Zip	:	92357-0001
Country	:	US
Telephone Number	:	909-825-7084
Fax Number	:	909-777-3263

Provider Business Practice Location Address
First Line	:	11201 BENTON ST / 119
Second Line	:
City	:	LOMA LINDA
State	:	CA
Zip	:	92357-0001
Country	:	US
Telephone Number	:	909-825-7084
Fax Number	:	909-777-3263

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	07/08/2022

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