Healthcare Provider Details

I. General information

NPI: 1760815781
Provider Name (Legal Business Name): VITACARE PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2447 TELEGRAPH AVE
OAKLAND CA
94612-2404
US

IV. Provider business mailing address

2447 TELEGRAPH AVE
OAKLAND CA
94612-2404
US

V. Phone/Fax

Practice location:
  • Phone: 510-832-7500
  • Fax: 510-832-2009
Mailing address:
  • Phone: 510-832-7500
  • Fax: 510-832-2009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number51535
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: YONATHAN SEYOUM
Title or Position: OWNER, AO, PHCY MANAGER, PIC
Credential: RPH
Phone: 510-832-7500