Healthcare Provider Details

I. General information

NPI: 1548969058
Provider Name (Legal Business Name): ANDREW BEYERS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4184 PIEDMONT AVE STE C
OAKLAND CA
94611-5174
US

IV. Provider business mailing address

4184 PIEDMONT AVE # CB
OAKLAND CA
94611-5174
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-1559
  • Fax:
Mailing address:
  • Phone: 510-428-1559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number44183
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number50814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: