MEDICARE: GARRET NAKATA

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	72647	CA
2	183500000X	Pharmacist	3555	HI

General Provider Information

NPI Number	:	1619349669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARRET NAKATA

Provider Business Mailing Address
First Line	:	2616 GLEN COTSWOLD CT
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95148-2544
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14830 HIGHWAY 4
Second Line	:
City	:	DISCOVERY BAY
State	:	CA
Zip	:	94505-2236
Country	:	US
Telephone Number	:	925-240-7189
Fax Number	:	925-240-7970

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

Provider Enumeration Date	:	10/28/2015
Last Update Date	:	10/28/2015

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Directions to “ GARRET NAKATA ” Practice Location

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