MEDICARE: DR. DARREN MASAHARU KOBA PHARMD

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	54874	CA

General Provider Information

NPI Number	:	1720250251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARREN MASAHARU KOBA PHARMD

Provider Business Mailing Address
First Line	:	1717 PUEBLO CREST LN
Second Line	:
City	:	LA HABRA HEIGHTS
State	:	CA
Zip	:	90631-8326
Country	:	US
Telephone Number	:	714-595-8963
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 PUEBLO CREST LN
Second Line	:
City	:	LA HABRA HEIGHTS
State	:	CA
Zip	:	90631-8326
Country	:	US
Telephone Number	:	714-595-8963
Fax Number	:

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

Provider Enumeration Date	:	03/25/2008
Last Update Date	:	03/25/2008

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