Provider Demographics
NPI:1477073963
Name:FUKUMOTO, DANIEL TOSHIHIKO (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:TOSHIHIKO
Last Name:FUKUMOTO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4913 PASEO DEL PAVON
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6268
Mailing Address - Country:US
Mailing Address - Phone:310-483-5432
Mailing Address - Fax:
Practice Address - Street 1:CVS PHARMACY
Practice Address - Street 2:9618 W. PICO BLVD
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035
Practice Address - Country:US
Practice Address - Phone:310-858-1855
Practice Address - Fax:310-858-1070
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37405183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist