Provider Demographics
NPI:1194849679
Name:OGAWA, PETER JEFFREY (PHARMD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JEFFREY
Last Name:OGAWA
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 1:680 E WOODHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1286
Mailing Address - Country:US
Mailing Address - Phone:559-434-6550
Mailing Address - Fax:
Practice Address - Street 1:7257 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2950
Practice Address - Country:US
Practice Address - Phone:559-451-3632
Practice Address - Fax:559-431-5827
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39724183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist