Provider Demographics
NPI:1770866303
Name:SAKATA, MARK T (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:T
Last Name:SAKATA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14780 S HARLAN RD
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:CA
Mailing Address - Zip Code:95330-9719
Mailing Address - Country:US
Mailing Address - Phone:209-858-2801
Mailing Address - Fax:209-858-5892
Practice Address - Street 1:14780 S HARLAN RD
Practice Address - Street 2:
Practice Address - City:LATHROP
Practice Address - State:CA
Practice Address - Zip Code:95330-9719
Practice Address - Country:US
Practice Address - Phone:209-858-2801
Practice Address - Fax:209-858-5892
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29441183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist