Healthcare Provider Details

I. General information

NPI: 1205926227
Provider Name (Legal Business Name): GUSTAVO ADOLFO SILVA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 12/21/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1795 2ND ST STE B
BERKELEY CA
94710-1704
US

IV. Provider business mailing address

1795 2ND ST STE B
BERKELEY CA
94710-1704
US

V. Phone/Fax

Practice location:
  • Phone: 510-559-5440
  • Fax:
Mailing address:
  • Phone: 510-559-5440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number45409
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: