Healthcare Provider Details

I. General information

NPI: 1861320020
Provider Name (Legal Business Name): BENJAMIN BIMANYWARUHANGA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 BROADWAY
OAKLAND CA
94612-2115
US

IV. Provider business mailing address

1721 BROADWAY
OAKLAND CA
94612-2115
US

V. Phone/Fax

Practice location:
  • Phone: 707-653-6723
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberINT53143
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: