Provider Demographics
NPI:1093812273
Name:CUTLER PHARMACY
Entity Type:Organization
Organization Name:CUTLER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:MITSUO
Authorized Official - Last Name:NAGATA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:559-528-4791
Mailing Address - Street 1:40665 ROAD 128
Mailing Address - Street 2:
Mailing Address - City:CUTLER
Mailing Address - State:CA
Mailing Address - Zip Code:93615-2003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:559-528-2438
Practice Address - Street 1:40665 ROAD 128
Practice Address - Street 2:
Practice Address - City:CUTLER
Practice Address - State:CA
Practice Address - Zip Code:93615-2003
Practice Address - Country:US
Practice Address - Phone:559-528-4791
Practice Address - Fax:559-528-2438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20510183500000X
CAPHY21599332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA215990Medicaid
CA0531156OtherNABP #
CAPHA215990Medicaid