1598930067 NPI number — THE WEST OAKLAND HEALTH CENTER PHARMACY

Table of content: (NPI 1598930067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598930067 NPI number — THE WEST OAKLAND HEALTH CENTER PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE WEST OAKLAND HEALTH CENTER PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598930067
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 ADELINE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94607-2608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-835-9610
Provider Business Mailing Address Fax Number:
510-272-0209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 ADELINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94607-2608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-835-9610
Provider Business Practice Location Address Fax Number:
510-272-0209
Provider Enumeration Date:
04/25/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCCABE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CHIEF PHARMACY OFFICER
Authorized Official Telephone Number:
510-835-9610

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X , with the licence number: PHY16560 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)