Provider Demographics
NPI:1043502289
Name:KOBASHI, CLYDE R (PHARMD)
Entity Type:Individual
Prefix:
First Name:CLYDE
Middle Name:R
Last Name:KOBASHI
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 1:1237 W CARSON ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2009
Mailing Address - Country:US
Mailing Address - Phone:310-320-4534
Mailing Address - Fax:310-320-8211
Practice Address - Street 1:1237 W CARSON ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2009
Practice Address - Country:US
Practice Address - Phone:310-320-4534
Practice Address - Fax:310-320-8211
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist