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General NPI Number Information
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NPI Number | 1619203841
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Entity Type | Organization
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Legal Business Name | FRUITVALE AVENUE PHARMACY INC
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Dates
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Enumeration Date | 10/22/2009
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Last Update Date | 07/17/2015
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Provider Practice Location Address
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Address Line | 2693 FRUITVALE AVE
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City | OAKLAND
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State | CA
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Zip | 94601-2034
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Country | US
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Telephone | 510-261-1412
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Fax | 510-261-1414
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Provider Business Mailing Address
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Address Line | 7400 MACARTHUR BLVD STE B
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City | OAKLAND
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State | CA
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Zip | 94605-2939
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Country | US
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Telephone | 510-261-1412
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Fax | 510-261-1414
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | KALPESH PATEL
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Credential | RPH
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Telephone | 510-406-3089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 50064
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License Number State | CA
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