Provider Demographics
NPI:1992179980
Name:TAKASAKI, TODD (RPH)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:TAKASAKI
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 1:12031 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-2814
Mailing Address - Country:US
Mailing Address - Phone:714-530-5280
Mailing Address - Fax:714-530-8360
Practice Address - Street 1:12031 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-2814
Practice Address - Country:US
Practice Address - Phone:714-530-5280
Practice Address - Fax:714-530-8360
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-14
Last Update Date:2015-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56312183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist