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General NPI Number Information
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NPI Number | 1467737643
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Entity Type | Organization
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Legal Business Name | DRATE PHARMACY
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 04/15/2015
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Provider Practice Location Address
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Address Line | 3219 ADELINE ST
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City | BERKELEY
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State | CA
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Zip | 94703-2467
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Country | US
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Telephone | 510-589-5989
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Fax | 510-969-4705
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Provider Business Mailing Address
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Address Line | 3219 ADELINE ST
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City | BERKELEY
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State | CA
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Zip | 94703-2467
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Country | US
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Telephone | 510-589-5989
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Fax | 510-969-4705
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MR. KENNETH OKWUEGBE
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Credential |
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Telephone | 510-589-5989
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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 | 53329
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License Number State | CA
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