Provider Demographics
NPI:1598913311
Name:YABUMOTO, CRAIG KENNETH (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:KENNETH
Last Name:YABUMOTO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N JACKSON AVE STE 103
Mailing Address - Street 2:SUITE #103
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1924
Mailing Address - Country:US
Mailing Address - Phone:408-259-1000
Mailing Address - Fax:408-272-2342
Practice Address - Street 1:115 N JACKSON AVE STE 103
Practice Address - Street 2:SUITE #103
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1924
Practice Address - Country:US
Practice Address - Phone:408-259-1000
Practice Address - Fax:408-272-2342
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44643183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA44643OtherSTATE LICENSE