Healthcare Provider Details

I. General information

NPI: 1053792416
Provider Name (Legal Business Name): ELDEN VIEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 HOWE ST
OAKLAND CA
94611-5312
US

IV. Provider business mailing address

3291 MIRAGE WAY
SAN JOSE CA
95135-2317
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number71256
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: