Provider Demographics
NPI:1811553159
Name:ISHIMOTO, TRICIA MASAYE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:MASAYE
Last Name:ISHIMOTO
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 1:4040 CLUBVIEW CT
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5704
Mailing Address - Country:US
Mailing Address - Phone:916-759-8708
Mailing Address - Fax:
Practice Address - Street 1:3251 STANFORD RANCH RD
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5553
Practice Address - Country:US
Practice Address - Phone:916-435-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist