=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679640924
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SECURITY PHARMACY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2006
-----------------------------------------------------
Last Update Date | 09/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 954 W FOOTHILL BLVD STE 6D
-----------------------------------------------------
City | UPLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91786-3782
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-608-1832
-----------------------------------------------------
Fax | 909-608-1871
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 954 W FOOTHILL BLVD STE 6D
-----------------------------------------------------
City | UPLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91786-3782
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-608-1832
-----------------------------------------------------
Fax | 909-608-1871
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. DAVID ISAMI IGARASHI
-----------------------------------------------------
Credential | PHARM.D.
-----------------------------------------------------
Telephone | 909-608-1832
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------