Provider Demographics
NPI:1568562452
Name:TO, BAU (RPH)
Entity Type:Individual
Prefix:MR
First Name:BAU
Middle Name:
Last Name:TO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 COOPER RD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-5427
Mailing Address - Country:US
Mailing Address - Phone:805-483-1121
Mailing Address - Fax:805-483-1121
Practice Address - Street 1:629 COOPER RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-5427
Practice Address - Country:US
Practice Address - Phone:805-483-1121
Practice Address - Fax:805-483-1121
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH40948183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0526662OtherWELLCARE HEALTH PLAN
CA0526662OtherBLUE CROSS/WELLPOINT
CA0526662OtherPRESCRIPTION SOLUTIONS
CA0526662OtherWESTERN GROWERS
CAPHA412250Medicaid
CAPHY41225OtherSTATE LICENSE
CA0526662OtherAETNA
0526662OtherNCPDP
CA0526662OtherHUMANA