Healthcare Provider Details

I. General information

NPI: 1992805949
Provider Name (Legal Business Name): CALIFORNIA STATE UNIVERSITY EAST BAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25800 CARLOS BEE BLVD
HAYWARD CA
94542-3000
US

IV. Provider business mailing address

25800 CARLOS BEE BLVD
HAYWARD CA
94542-3000
US

V. Phone/Fax

Practice location:
  • Phone: 510-885-3650
  • Fax: 510-885-7477
Mailing address:
  • Phone: 510-885-3650
  • Fax: 510-885-7477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPHE17358
License Number StateCA

VIII. Authorized Official

Name: ROBERT MAR
Title or Position: PIC
Credential:
Phone: 510-885-3650