Provider Demographics
NPI:1952889537
Name:HATANAKA, FRANK HISATO
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:HISATO
Last Name:HATANAKA
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 1:8826 HERITAGE CT
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-9752
Mailing Address - Country:US
Mailing Address - Phone:530-244-0180
Mailing Address - Fax:
Practice Address - Street 1:1060 E CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002
Practice Address - Country:US
Practice Address - Phone:530-221-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-05
Last Update Date:2018-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFRHATANA1Medicaid