Healthcare Provider Details

I. General information

NPI: 1801857958
Provider Name (Legal Business Name): HEALTHCARE ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 B ST
HAYWARD CA
94541-5109
US

IV. Provider business mailing address

925 B ST
HAYWARD CA
94541-5109
US

V. Phone/Fax

Practice location:
  • Phone: 510-538-9711
  • Fax: 510-538-3204
Mailing address:
  • Phone: 510-538-9711
  • Fax: 510-538-3204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY50187
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA GOLUNOVA
Title or Position: DIRECTOR
Credential:
Phone: 415-867-4177