Healthcare Provider Details

I. General information

NPI: 1043651409
Provider Name (Legal Business Name): EFREN A BOSE JR. PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 BANCROFT WAY
BERKELEY CA
94720-4300
US

IV. Provider business mailing address

2425 CHANNING WAY STE B
BERKELEY CA
94704-2260
US

V. Phone/Fax

Practice location:
  • Phone: 510-642-3249
  • Fax: 510-642-5759
Mailing address:
  • Phone: 415-996-7092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH-4807
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number68919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: