Healthcare Provider Details

I. General information

NPI: 1578571030
Provider Name (Legal Business Name): ROYAL MEDICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 TELEGRAPH AVE
BERKELEY CA
94705-2017
US

IV. Provider business mailing address

2929 TELEGRAPH AVE
BERKELEY CA
94705-2017
US

V. Phone/Fax

Practice location:
  • Phone: 510-540-0494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0600026208
License Number StateCA

VIII. Authorized Official

Name: MR. TENGIZ IOSEBASHVILI
Title or Position: PRESIDENT
Credential:
Phone: 510-540-0494