Provider Demographics
NPI:1346517406
Name:SAKAMOTO, LOIS
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:SAKAMOTO
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 1:17355 FLAME TREE CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3521
Mailing Address - Country:US
Mailing Address - Phone:714-968-2065
Mailing Address - Fax:
Practice Address - Street 1:5005 BALL RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-3643
Practice Address - Country:US
Practice Address - Phone:714-886-1079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49180183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist