Provider Demographics
NPI:1760532071
Name:DAVID ISAMI IGARASHI
Entity Type:Organization
Organization Name:DAVID ISAMI IGARASHI
Other - Org Name:BALDWIN HILLS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:IGARASHI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:909-608-1832
Mailing Address - Street 1:811 E 11TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4871
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:811 E 11TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4871
Practice Address - Country:US
Practice Address - Phone:909-981-8818
Practice Address - Fax:909-608-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY34984333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0595744OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0595744OtherOTHER ID NUMBER
CAPHA349840Medicaid