Provider Demographics
NPI:1063733681
Name:NAKANISHI, JAMES M (PHARM D)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:NAKANISHI
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1654 N HALE AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1240
Mailing Address - Country:US
Mailing Address - Phone:626-839-3052
Mailing Address - Fax:
Practice Address - Street 1:17550 CASTLETON ST
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1701
Practice Address - Country:US
Practice Address - Phone:626-839-3052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist