Provider Demographics
NPI:1598953747
Name:IKEDA, STEPHANIE KAYOKO (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KAYOKO
Last Name:IKEDA
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 1:19331 WEYMOUTH LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-2040
Mailing Address - Country:US
Mailing Address - Phone:714-964-2064
Mailing Address - Fax:
Practice Address - Street 1:4175 E LA PALMA AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-1842
Practice Address - Country:US
Practice Address - Phone:714-279-4706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60072183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist