Provider Demographics
NPI:1134750722
Name:KAWAMURA, CYNTHIA (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:KAWAMURA
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 MORNINGHOME RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-3612
Mailing Address - Country:US
Mailing Address - Phone:925-389-6260
Mailing Address - Fax:
Practice Address - Street 1:558 MORNINGHOME RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-3612
Practice Address - Country:US
Practice Address - Phone:925-389-6260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109724247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA109724Medicaid
CA109724OtherPHARMACY TECH LICENSE