Organization
ALTA BATES SUMMIT MEDICAL CENTER
Active
Organization
ALTA BATES SUMMIT MEDICAL CENTER
Active
Other names
East Bay AIDS Center Outpatient Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE SO PHARM.D. (PHARMACIST)
(510) 869-8456
Entity
Organization
Contact information
Practice address
3100 SUMMIT ST, OAKLAND, CA 94609-3412
(510) 869-8451
(510) 869-8458
Mailing address
PO BOX 742585, LOS ANGELES, CA 90074-2585
(510) 869-8451
(510) 869-8458
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY49947
CA
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780813485
—
CA
01
—
2121109
PK
—
Enumeration date
07/02/2009
Last updated
01/20/2022
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