Provider Demographics
NPI:1215243902
Name:KUSUMOTO, JAMIE MARI (PHARMD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:MARI
Last Name:KUSUMOTO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 BATTERY ST
Mailing Address - Street 2:APT 318
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-2310
Mailing Address - Country:US
Mailing Address - Phone:626-945-0651
Mailing Address - Fax:
Practice Address - Street 1:4131 GEARY BLVD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3101
Practice Address - Country:US
Practice Address - Phone:415-833-3649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist