Provider Demographics
NPI:1255690335
Name:FUKUSHIMA, WENDY ABE (PHARMD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ABE
Last Name:FUKUSHIMA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FREMONT LN
Mailing Address - Street 2:
Mailing Address - City:COTO DE CAZA
Mailing Address - State:CA
Mailing Address - Zip Code:92679-3630
Mailing Address - Country:US
Mailing Address - Phone:949-500-6661
Mailing Address - Fax:
Practice Address - Street 1:500 SUPERIOR AVE STE 150
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3676
Practice Address - Country:US
Practice Address - Phone:949-759-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH41141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist