Organization
ELEPHANT PHARMACY OPERATING CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA SICKLEY (PRESIDENT)
(510) 868-3021
Entity
Organization
Contact information
Practice address
909 GRAND AVE, SAN RAFAEL, CA 94901-3505
(415) 462-6001
(415) 462-6003
Mailing address
1250 9TH ST, BERKELEY, CA 94710-1501
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY47279
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5617189
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
06/20/2006
Last updated
07/26/2007
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