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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