Provider Demographics
NPI:1699144592
Name:ITO, JENNIFER SAYURI (PHARM D)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SAYURI
Last Name:ITO
Suffix:
Gender:F
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 1:16182 MELODY LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-2355
Mailing Address - Country:US
Mailing Address - Phone:714-624-1486
Mailing Address - Fax:
Practice Address - Street 1:2020 N RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92377-4600
Practice Address - Country:US
Practice Address - Phone:909-873-2835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73481183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist