Healthcare Provider Details

I. General information

NPI: 1992686091
Provider Name (Legal Business Name): ELIZABETH MORTON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 10/24/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 ASHBY AVE
BERKELEY CA
94705-2067
US

IV. Provider business mailing address

354 SANTA CLARA AVE
OAKLAND CA
94610-2626
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-3483
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number74808
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: