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General NPI Number Information
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NPI Number | 1760427900
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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 | 06/20/2006
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Last Update Date | 07/26/2007
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Provider Practice Location Address
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Address Line | 909 GRAND AVE
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City | SAN RAFAEL
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State | CA
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Zip | 94901-3505
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Country | US
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Telephone | 415-462-6001
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Fax | 415-462-6003
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Provider Business Mailing Address
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Address Line | 1250 9TH ST
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City | BERKELEY
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State | CA
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Zip | 94710-1501
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SANDRA SICKLEY
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Credential |
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Telephone | 510-868-3021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | 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 | PHY47279
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License Number State | CA
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