Provider Demographics
NPI:1629693882
Name:NISHIKAWA, NATALIE JOY (PHARMD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:JOY
Last Name:NISHIKAWA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:JOY
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2917 BAY VILLAGE CIR APT 1017
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2279
Mailing Address - Country:US
Mailing Address - Phone:760-814-0807
Mailing Address - Fax:
Practice Address - Street 1:950 CODDINGTOWN CTR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-3512
Practice Address - Country:US
Practice Address - Phone:707-596-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-13
Last Update Date:2022-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82371183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist