Provider Demographics
NPI:1750877338
Name:MORITA, ROY YASUO (PHARMD)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:YASUO
Last Name:MORITA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 MONTECITO DR
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-2927
Mailing Address - Country:US
Mailing Address - Phone:626-388-3343
Mailing Address - Fax:
Practice Address - Street 1:1827 WALNUT GROVE AVE
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-3789
Practice Address - Country:US
Practice Address - Phone:626-573-5094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist