Healthcare Provider Details

I. General information

NPI: 1932592011
Provider Name (Legal Business Name): TERRY PHONXANASINH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 GILMAN ST
BERKELEY CA
94710-1532
US

IV. Provider business mailing address

309 E 15TH ST
OAKLAND CA
94606-2320
US

V. Phone/Fax

Practice location:
  • Phone: 510-528-8274
  • Fax:
Mailing address:
  • Phone: 847-873-5441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number72357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: