Provider Demographics
NPI:1053308957
Name:IWANAGA, MUSUMI (PHARMD,RPH)
Entity Type:Individual
Prefix:DR
First Name:MUSUMI
Middle Name:
Last Name:IWANAGA
Suffix:
Gender:M
Credentials:PHARMD,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22603 LILAC CT
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91390-4001
Mailing Address - Country:US
Mailing Address - Phone:661-296-3322
Mailing Address - Fax:
Practice Address - Street 1:12737 GLENOAKS BLVD
Practice Address - Street 2:#27
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-4704
Practice Address - Country:US
Practice Address - Phone:818-362-6894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABS5876252183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0579764OtherNABP