Jimmy Ken Eitoku, PHARMD
Individual provider Active NPI Pharmacist · Gonzales, CA
NPI 1609883156 · NPPES record last updated Mar 17, 2023
Key facts
- NPI
- 1609883156
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 38620 (CA)
- Practice address
- 18 4TH Street
Gonzales, CA 93926-0808 - NPI assigned
- Aug 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38620 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eitoku Company Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 38620 | CA | Yes |
Addresses
Primary practice location
18 4TH Street
Gonzales, CA 93926-0808
Mailing address
PO Box 808
Gonzales, CA 93926-0808
Phone (831) 675-3643
Other providers in Gonzales, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.