Healthcare Provider Details

I. General information

NPI: 1619369857
Provider Name (Legal Business Name): MR. AMOS UKOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2015
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3514 MIDVALE AVE
OAKLAND CA
94602-3828
US

IV. Provider business mailing address

3514 MIDVALE AVE
OAKLAND CA
94602-3828
US

V. Phone/Fax

Practice location:
  • Phone: 510-500-3803
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number49883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: