Provider Demographics
NPI:1225731342
Name:YOSHIKAWA, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:YOSHIKAWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 PACIFIC AVE UNIT 309
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-3535
Mailing Address - Country:US
Mailing Address - Phone:412-352-5854
Mailing Address - Fax:
Practice Address - Street 1:1624 LASKIN RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-7507
Practice Address - Country:US
Practice Address - Phone:757-425-9474
Practice Address - Fax:757-425-9061
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1644690183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician