Provider Demographics
NPI:1679640924
Name:SECURITY PHARMACY, INC
Entity Type:Organization
Organization Name:SECURITY PHARMACY, INC
Other - Org Name:UPLAND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ISAMI
Authorized Official - Last Name:IGARASHI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:909-608-1832
Mailing Address - Street 1:1183 E FOOTHILL BLVD
Mailing Address - Street 2:#130
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4084
Mailing Address - Country:US
Mailing Address - Phone:909-608-1832
Mailing Address - Fax:909-608-1871
Practice Address - Street 1:1183 E FOOTHILL BLVD
Practice Address - Street 2:#130
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4084
Practice Address - Country:US
Practice Address - Phone:909-608-1832
Practice Address - Fax:909-608-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY445363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA445360Medicaid
CAPHA445360Medicaid