Healthcare Provider Details

I. General information

NPI: 1265701106
Provider Name (Legal Business Name): SAL'S PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 SOLANO AVE STE A
BERKELEY CA
94707-2322
US

IV. Provider business mailing address

5754 SKYVIEW PL
EL SOBRANTE CA
94803-3272
US

V. Phone/Fax

Practice location:
  • Phone: 510-525-6500
  • Fax: 510-525-6502
Mailing address:
  • Phone: 510-525-6500
  • Fax: 510-525-6502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY 50800
License Number StateCA

VIII. Authorized Official

Name: MR. SADALLA H NASSAR
Title or Position: MR
Credential: RPH
Phone: 510-367-9402