Provider Demographics
NPI:1457645640
Name:WATANABE, CHERIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHERIN
Middle Name:
Last Name:WATANABE
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 1:4200 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5250
Mailing Address - Country:US
Mailing Address - Phone:909-579-3041
Mailing Address - Fax:909-579-3041
Practice Address - Street 1:4200 E 4TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-5250
Practice Address - Country:US
Practice Address - Phone:909-579-3041
Practice Address - Fax:909-579-3041
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-05
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58957183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist