Healthcare Provider Details

I. General information

NPI: 1942581996
Provider Name (Legal Business Name): LAWRENCE CHATMON PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2011
Last Update Date: 09/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 TELEGRAPH AVE
BERKELEY CA
94704-1613
US

IV. Provider business mailing address

2310 TELEGRAPH AVE
BERKELEY CA
94704-1613
US

V. Phone/Fax

Practice location:
  • Phone: 510-848-5121
  • Fax: 510-848-5350
Mailing address:
  • Phone: 510-848-5121
  • Fax: 510-848-5350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number58743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: