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General NPI Number Information
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NPI Number | 1376675751
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Entity Type | Organization
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Legal Business Name | THE APOTHECARY EASTMONT TOWN CENTER
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 7200 BANCROFT AVE SUITE #268
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City | OAKLAND
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State | CA
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Zip | 94605-2468
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Country | US
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Telephone | 510-638-7323
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Fax | 510-430-2860
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Provider Business Mailing Address
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Address Line | 7200 BANCROFT AVE SUITE #268
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City | OAKLAND
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State | CA
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Zip | 94605-2468
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Country | US
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Telephone | 510-638-7323
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Fax | 510-430-2860
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | DR. MICHAEL PONDER
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Credential | PHARM.D.
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Telephone | 510-638-7323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY46625
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License Number State | CA
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