Provider Demographics
NPI:1659072783
Name:KAWAHARA, NANCY EDMAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:EDMAN
Last Name:KAWAHARA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:JULIA
Other - Last Name:EDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 79552
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92877-0185
Mailing Address - Country:US
Mailing Address - Phone:951-660-9181
Mailing Address - Fax:909-558-7973
Practice Address - Street 1:24745 STEWART ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-1719
Practice Address - Country:US
Practice Address - Phone:909-558-7401
Practice Address - Fax:909-558-7973
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-036720183500000X
CA37215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist