Healthcare Provider Details

I. General information

NPI: 1467737643
Provider Name (Legal Business Name): DRATE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3219 ADELINE ST
BERKELEY CA
94703-2467
US

IV. Provider business mailing address

3219 ADELINE ST
BERKELEY CA
94703-2467
US

V. Phone/Fax

Practice location:
  • Phone: 510-589-5989
  • Fax: 510-969-4705
Mailing address:
  • Phone: 510-589-5989
  • Fax: 510-969-4705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number53329
License Number StateCA

VIII. Authorized Official

Name: MR. KENNETH OKWUEGBE
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 510-589-5989