Healthcare Provider Details

I. General information

NPI: 1326554239
Provider Name (Legal Business Name): SUTTER BAY HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2017
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 DWIGHT WAY STE 2182
BERKELEY CA
94704-2608
US

IV. Provider business mailing address

2001 DWIGHT WAY STE 2182
BERKELEY CA
94704-2608
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-6550
  • Fax: 510-204-5895
Mailing address:
  • Phone: 510-204-6550
  • Fax: 510-204-5895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPHY52043
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY52043
License Number StateCA

VIII. Authorized Official

Name: MICHAEL FEDERICO
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARMD
Phone: 510-869-8452