Provider Demographics
NPI:1073899472
Name:OTOMO, CHIEKO (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHIEKO
Middle Name:
Last Name:OTOMO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CHIEKO
Other - Middle Name:OTOMO
Other - Last Name:HEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4647 ZION AVE
Mailing Address - Street 2:ONCOLOGY PHARMACY ROOM 4825
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120
Mailing Address - Country:US
Mailing Address - Phone:619-528-5168
Mailing Address - Fax:
Practice Address - Street 1:4647 ZION AVE
Practice Address - Street 2:ONCOLOGY PHARMACY ROOM 4825
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120
Practice Address - Country:US
Practice Address - Phone:619-528-5168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-30
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0550771835X0200X
CA625101835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology