Provider Demographics
NPI:1255781076
Name:FUJIMOTO, JONATHAN KIYOSHI (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:KIYOSHI
Last Name:FUJIMOTO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 EVENING CANYON RD
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-2612
Mailing Address - Country:US
Mailing Address - Phone:714-514-0485
Mailing Address - Fax:401-652-0586
Practice Address - Street 1:777 S HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-6882
Practice Address - Country:US
Practice Address - Phone:714-514-0485
Practice Address - Fax:401-652-0586
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist