Healthcare Provider Details

I. General information

NPI: 1063707677
Provider Name (Legal Business Name): SUSAN N KALAEI PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 MACDONALD AVE T1507
RICHMOND CA
94805-2307
US

IV. Provider business mailing address

4500 MACDONALD AVE T1507
RICHMOND CA
94805-2307
US

V. Phone/Fax

Practice location:
  • Phone: 510-253-1001
  • Fax: 510-253-1011
Mailing address:
  • Phone: 510-253-1001
  • Fax: 510-253-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA 43149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: