Provider Demographics
NPI:1275849226
Name:KOMESU, ANDREW AKIRA (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:AKIRA
Last Name:KOMESU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5807 TOPANGA CANYON BLVD APT J307
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-4645
Mailing Address - Country:US
Mailing Address - Phone:818-436-2439
Mailing Address - Fax:
Practice Address - Street 1:5807 TOPANGA CANYON BLVD APT J307
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-4645
Practice Address - Country:US
Practice Address - Phone:818-436-2439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist