Healthcare Provider Details

I. General information

NPI: 1730411836
Provider Name (Legal Business Name): HEALTH VENTURES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 DWIGHT WAY RM 1380D
BERKELEY CA
94704-2608
US

IV. Provider business mailing address

PO BOX 742432
LOS ANGELES CA
90074-2432
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number50163
License Number StateCA

VIII. Authorized Official

Name: CHUCK PROSPER
Title or Position: VP HEALTH VENTURES, INC.
Credential: RPH
Phone: 510-655-4000