Provider Demographics
NPI:1154984789
Name:MIZOGUCHI, NEILL S (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NEILL
Middle Name:S
Last Name:MIZOGUCHI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6826 E HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-6469
Mailing Address - Country:US
Mailing Address - Phone:714-315-1791
Mailing Address - Fax:
Practice Address - Street 1:2011 E LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-2744
Practice Address - Country:US
Practice Address - Phone:714-991-9161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42712183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist