Healthcare Provider Details

I. General information

NPI: 1740276286
Provider Name (Legal Business Name): ELEPHANT PHARMACY OPERATING CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 SHATTUCK AVE
BERKELEY CA
94709-1611
US

IV. Provider business mailing address

1607 SHATTUCK AVE
BERKELEY CA
94709-1611
US

V. Phone/Fax

Practice location:
  • Phone: 510-549-9201
  • Fax: 510-549-9204
Mailing address:
  • Phone: 510-549-9201
  • Fax: 510-549-9204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH50642
License Number StateCA

VIII. Authorized Official

Name: TERRY CATER
Title or Position: VP OF PHARMACY
Credential: R.PH.
Phone: 510-549-9201