Healthcare Provider Details

I. General information

NPI: 1093812273
Provider Name (Legal Business Name): CUTLER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40665 ROAD 128
CUTLER CA
93615-2003
US

IV. Provider business mailing address

40665 ROAD 128
CUTLER CA
93615-2003
US

V. Phone/Fax

Practice location:
  • Phone: 559-528-4791
  • Fax: 559-528-2438
Mailing address:
  • Phone:
  • Fax: 559-528-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20510
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPHY21599
License Number StateCA

VIII. Authorized Official

Name: MR. GORDON MITSUO NAGATA
Title or Position: PRES/PHARMACIST
Credential: PHARM D
Phone: 559-528-4791