1467737643 NPI number — DRATE PHARMACY

Table of content: DR. ELIZABETH CASE LICSW, PHD (NPI 1427387117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467737643 NPI number — DRATE PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRATE 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:
1467737643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3219 ADELINE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERKELEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94703-2467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-589-5989
Provider Business Mailing Address Fax Number:
510-969-4705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3219 ADELINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94703-2467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-589-5989
Provider Business Practice Location Address Fax Number:
510-969-4705
Provider Enumeration Date:
10/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
OKWUEGBE
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST IN CHARGE
Authorized Official Telephone Number:
510-589-5989

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  53329 , 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)

  • Identifier: 53329 . This is a "CALIFORNIA STATE BOARD OF PHARMACY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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