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General NPI Number Information
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NPI Number | 1881733046
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Entity Type | Organization
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Legal Business Name | ELEPHANT PHARMACY OPERATING CORPORATION
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1388 S CALIFORNIA BLVD
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City | WALNUT CREEK
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State | CA
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Zip | 94596-5125
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Country | US
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Telephone | 925-658-5301
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Fax | 925-658-5303
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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 | 510-868-3021
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Fax | 510-868-3021
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. 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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 48392
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License Number State | CA
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