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NPI Code Detail

MEDICARE: ANNIE PARK RPH

MEDICARE: ANNIE PARK RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist47909CA

General Provider Information

NPI Number : 1588917876
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNIE PARK RPH
Provider Business Mailing Address
First Line : 1607 SHATTUCK AVE
Second Line :
City : BERKELEY
State : CA
Zip : 94709-1611
Country : US
Telephone Number : 510-423-9430
Fax Number :
Provider Business Practice Location Address
First Line : 1607 SHATTUCK AVE
Second Line :
City : BERKELEY
State : CA
Zip : 94709-1611
Country : US
Telephone Number : 510-423-9430
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2012
Last Update Date : 10/24/2012

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Directions to “ ANNIE PARK RPH” Practice Location

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