Healthcare Provider Details

I. General information

NPI: 1376162651
Provider Name (Legal Business Name): JEFFREY CHI HUA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 BROADWAY
OAKLAND CA
94611-5730
US

IV. Provider business mailing address

12 MARGARITA TER
NOVATO CA
94947-4726
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-5207
  • Fax:
Mailing address:
  • Phone: 415-912-9465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number82830
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: