Provider Demographics
NPI:1205918778
Name:YAMAMOTO SKOWRON, DIANE MARIE (PHARMD, CCH, CH, CI)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:YAMAMOTO SKOWRON
Suffix:
Gender:F
Credentials:PHARMD, CCH, CH, CI
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:MARIE
Other - Last Name:YAMAMOTO SKOWRON OUADFEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCH, RSHOM, CI, CH,
Mailing Address - Street 1:1505 N EDGEMONT ST
Mailing Address - Street 2:PHARMACY
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5209
Mailing Address - Country:US
Mailing Address - Phone:323-783-4148
Mailing Address - Fax:323-783-5694
Practice Address - Street 1:6255 W SUNSET BLVD FL 21
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-7422
Practice Address - Country:US
Practice Address - Phone:323-860-5200
Practice Address - Fax:323-722-8040
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175L00000X
CA432781835N1003X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No175L00000XOther Service ProvidersHomeopath
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support