Provider Demographics
NPI:1871968537
Name:FUKUMOTO, ANITA (PHARMD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:FUKUMOTO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:WOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3701 BROADWAY
Mailing Address - Street 2:ONCOLOGY PHARMACY, 3RD FLOOR
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3701 BROADWAY
Practice Address - Street 2:ONCOLOGY PHARMACY, 3RD FLOOR
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5613
Practice Address - Country:US
Practice Address - Phone:510-752-6564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist