Provider Demographics
NPI:1073249793
Name:CALLOWAY, NATHANIEL II
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:CALLOWAY
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22530 3RD ST APT 204
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-2979
Mailing Address - Country:US
Mailing Address - Phone:510-459-6882
Mailing Address - Fax:
Practice Address - Street 1:3889 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-3808
Practice Address - Country:US
Practice Address - Phone:510-768-1034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85794183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist