Provider Demographics
NPI:1295715944
Name:SAGRADO, BALDOMERO JERUSALEM JR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BALDOMERO
Middle Name:JERUSALEM
Last Name:SAGRADO
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 W AINSLIE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-5632
Mailing Address - Country:US
Mailing Address - Phone:671-646-7205
Mailing Address - Fax:
Practice Address - Street 1:BUILDING K-1
Practice Address - Street 2:FARENHOLT STREET
Practice Address - City:AGANA HEIGHTS
Practice Address - State:GU
Practice Address - Zip Code:96919
Practice Address - Country:US
Practice Address - Phone:671-344-9354
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL51290986183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist