Healthcare Provider Details

I. General information

NPI: 1639892334
Provider Name (Legal Business Name): PEACE AMARACHI DURU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 MACDONALD AVE
RICHMOND CA
94805-2307
US

IV. Provider business mailing address

4763 BUCKBOARD WAY
RICHMOND CA
94803-3818
US

V. Phone/Fax

Practice location:
  • Phone: 510-253-1001
  • Fax:
Mailing address:
  • Phone: 918-630-4951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number85550
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: