Healthcare Provider Details

I. General information

NPI: 1245606037
Provider Name (Legal Business Name): GINA NAKATA PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2015
Last Update Date: 04/26/2024
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1795 2ND ST
BERKELEY CA
94710-1704
US

IV. Provider business mailing address

1254 65TH ST
EMERYVILLE CA
94608-1111
US

V. Phone/Fax

Practice location:
  • Phone: 510-559-5100
  • Fax:
Mailing address:
  • Phone: 916-770-5227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number68241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: