Provider Demographics
NPI:1265730675
Name:YOSHIMOTO, DEAN MICHAEL
Entity type:Individual
Prefix:MR
First Name:DEAN
Middle Name:MICHAEL
Last Name:YOSHIMOTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7607 BELMONT STAKES DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-6127
Mailing Address - Country:US
Mailing Address - Phone:804-561-2691
Mailing Address - Fax:804-561-1725
Practice Address - Street 1:15105 PATRICK HENRY HWY
Practice Address - Street 2:
Practice Address - City:AMELIA COURT HOUSE
Practice Address - State:VA
Practice Address - Zip Code:23002-4700
Practice Address - Country:US
Practice Address - Phone:804-561-2691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist