Provider Demographics
NPI:1952060865
Name:SUEHIRO, KEITH SHIGERU (PHARMD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:SHIGERU
Last Name:SUEHIRO
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 1:319 CANON DE PARAISO LN
Mailing Address - Street 2:
Mailing Address - City:LA CANADA FLINTRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2704
Mailing Address - Country:US
Mailing Address - Phone:818-636-5905
Mailing Address - Fax:
Practice Address - Street 1:319 CANON DE PARAISO LN
Practice Address - Street 2:
Practice Address - City:LA CANADA FLINTRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91011-2704
Practice Address - Country:US
Practice Address - Phone:818-636-5905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist