MEDICARE: MR. KENJI YOSHIMURS 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	PHA36884	CA

General Provider Information

NPI Number	:	1508841677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENJI YOSHIMURS RPH

Provider Business Mailing Address
First Line	:	811 C ST
Second Line	:
City	:	GALT
State	:	CA
Zip	:	95632-1706
Country	:	US
Telephone Number	:	209-745-1591
Fax Number	:	209-745-7493

Provider Business Practice Location Address
First Line	:	811 C ST
Second Line	:
City	:	GALT
State	:	CA
Zip	:	95632-1706
Country	:	US
Telephone Number	:	209-745-1591
Fax Number	:	209-745-7493

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	07/08/2007

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