MEDICARE: KOMAKI ENTERPRISES, INC

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	333600000X	Pharmacy	PHY42161	CA
2	332B00000X	Durable Medical Equipment & Medical Supplies	PHY42161	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0597611	OTHER		NCPDP NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	PHY42161	OTHER	CA	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1437148400
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOMAKI ENTERPRISES, INC

Provider Business Mailing Address
First Line	:	8575 LOS COCHES RD
Second Line	:	SUITE 5
City	:	EL CAJON
State	:	CA
Zip	:	92021-8815
Country	:	US
Telephone Number	:	619-561-5602
Fax Number	:	619-561-5933

Provider Business Practice Location Address
First Line	:	8575 LOS COCHES RD
Second Line	:	SUITE 5
City	:	EL CAJON
State	:	CA
Zip	:	92021-8815
Country	:	US
Telephone Number	:	619-561-5602
Fax Number	:	619-561-5933

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDWARD SAIJI KOMAKI
Credential	:	PHARM D
Telephone Number	:	619-561-5602

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	09/11/2025

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Directions to “KOMAKI ENTERPRISES, INC ” Practice Location

Language	Start Address	Practice Location

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