Healthcare Provider Details

I. General information

NPI: 1326411620
Provider Name (Legal Business Name): NOSA SULE PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 37TH ST
OAKLAND CA
94609-2331
US

IV. Provider business mailing address

733 37TH ST
OAKLAND CA
94609
US

V. Phone/Fax

Practice location:
  • Phone: 510-653-0526
  • Fax: 510-653-0560
Mailing address:
  • Phone: 510-653-0526
  • Fax: 510-653-0560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number56170
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: