Provider Demographics
NPI:1043651409
Name:BOSE, EFREN A JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EFREN
Middle Name:A
Last Name:BOSE
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 CHANNING WAY STE B
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2260
Mailing Address - Country:US
Mailing Address - Phone:415-996-7092
Mailing Address - Fax:
Practice Address - Street 1:2222 BANCROFT WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-4300
Practice Address - Country:US
Practice Address - Phone:510-642-3249
Practice Address - Fax:510-642-5759
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-4807183500000X
CA68919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist