Healthcare Provider Details

I. General information

NPI: 1598930067
Provider Name (Legal Business Name): THE WEST OAKLAND HEALTH CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 ADELINE ST
OAKLAND CA
94607-2608
US

IV. Provider business mailing address

700 ADELINE ST
OAKLAND CA
94607-2608
US

V. Phone/Fax

Practice location:
  • Phone: 510-835-9610
  • Fax: 510-272-0209
Mailing address:
  • Phone: 510-835-9610
  • Fax: 510-272-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPHY16560
License Number StateCA

VIII. Authorized Official

Name: JAMES P MCCABE
Title or Position: CHIEF PHARMACY OFFICER
Credential: RPH
Phone: 510-835-9610