Healthcare Provider Details

I. General information

NPI: 1528224011
Provider Name (Legal Business Name): LOGAN HISASHI TSUBOI SAITO PHARMD, BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17284 SLOVER AVE SUITE 204
FONTANA CA
92337-7584
US

IV. Provider business mailing address

17284 SLOVER AVE SUITE 204
FONTANA CA
92337-7584
US

V. Phone/Fax

Practice location:
  • Phone: 909-609-3338
  • Fax: 909-609-3306
Mailing address:
  • Phone: 909-609-3338
  • Fax: 909-609-3306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number61251
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: