Provider Demographics
NPI:1528224011
Name:SAITO, LOGAN HISASHI TSUBOI (PHARMD, BCPS)
Entity Type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:HISASHI TSUBOI
Last Name:SAITO
Suffix:
Gender:M
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17284 SLOVER AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-7584
Mailing Address - Country:US
Mailing Address - Phone:909-609-3338
Mailing Address - Fax:909-609-3306
Practice Address - Street 1:17284 SLOVER AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-7584
Practice Address - Country:US
Practice Address - Phone:909-609-3338
Practice Address - Fax:909-609-3306
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61251183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist