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General NPI Number Information
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NPI Number | 1972594448
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Entity Type | Organization
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Legal Business Name | FRUITVALE MEDICAL CENTER PHARMACY
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 3024 INTERNATIONAL BLVD
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City | OAKLAND
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State | CA
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Zip | 94601-2204
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Country | US
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Telephone | 510-535-1005
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Fax | 510-535-9374
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Provider Business Mailing Address
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Address Line | 3024 INTERNATIONAL BLVD
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City | OAKLAND
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State | CA
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Zip | 94601-2204
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Country | US
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Telephone | 510-535-1005
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Fax | 510-535-9374
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Authorized Official
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Title or Position | PHARMACIST OWNER
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Name | MR. KUO LIANG YANG
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Credential |
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Telephone | 510-535-1005
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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 | PHY35207
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License Number State | CA
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