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General NPI Number Information
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NPI Number | 1740276286
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Entity Type | Organization
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Legal Business Name | ELEPHANT PHARMACY OPERATING CORP
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1607 SHATTUCK AVE
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City | BERKELEY
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State | CA
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Zip | 94709-1611
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Country | US
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Telephone | 510-549-9201
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Fax | 510-549-9204
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Provider Business Mailing Address
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Address Line | 1607 SHATTUCK AVE
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City | BERKELEY
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State | CA
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Zip | 94709-1611
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Country | US
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Telephone | 510-549-9201
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Fax | 510-549-9204
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Authorized Official
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Title or Position | VP OF PHARMACY
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Name | TERRY CATER
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Credential | R.PH.
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Telephone | 510-549-9201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH50642
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License Number State | CA
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