Provider Demographics
NPI:1093180192
Name:TREMBLAY, MICHEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHEL
Middle Name:
Last Name:TREMBLAY
Suffix:
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 1:7414 DEERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2731
Mailing Address - Country:US
Mailing Address - Phone:508-463-6699
Mailing Address - Fax:
Practice Address - Street 1:15555 E 14TH ST
Practice Address - Street 2:STE 400
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1900
Practice Address - Country:US
Practice Address - Phone:510-276-2699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist