Provider Demographics
NPI:1104030105
Name:FUJIKAWA-DAVIS, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:FUJIKAWA-DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:HIROMI
Other - Last Name:FUJIKAWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:618 HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-1916
Mailing Address - Country:US
Mailing Address - Phone:510-215-7496
Mailing Address - Fax:
Practice Address - Street 1:892 SOUTHAMPTON RD
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-1907
Practice Address - Country:US
Practice Address - Phone:707-746-5565
Practice Address - Fax:707-746-6867
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 35965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist