Healthcare Provider Details

I. General information

NPI: 1902128648
Provider Name (Legal Business Name): NORTH EAST MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NORIEGA ST
SAN FRANCISCO CA
94122-4432
US

IV. Provider business mailing address

1520 STOCKTON ST
SAN FRANCISCO CA
94133-3354
US

V. Phone/Fax

Practice location:
  • Phone: 415-391-9686
  • Fax: 415-242-1781
Mailing address:
  • Phone: 415-391-9686
  • Fax: 415-391-9704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number50178
License Number StateCA

VIII. Authorized Official

Name: EDDIE CHAN
Title or Position: CEO
Credential:
Phone: 415-391-9686