Provider Demographics
NPI:1891375283
Name:NAKAMURA, BRYAN NOBORU (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:NOBORU
Last Name:NAKAMURA
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 1:112 LA CASA VIA STE 100
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3016
Mailing Address - Country:US
Mailing Address - Phone:925-939-6312
Mailing Address - Fax:
Practice Address - Street 1:112 LA CASA VIA STE 100
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3016
Practice Address - Country:US
Practice Address - Phone:925-939-6312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-10
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist