Provider Demographics
NPI:1114083482
Name:ALAMEDA HEALTH SYSTEM
Entity Type:Organization
Organization Name:ALAMEDA HEALTH SYSTEM
Other - Org Name:JOHN GEORGE PSYCHIATRIC PAVILLION PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF PHCY
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:YASAVOLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-437-5055
Mailing Address - Street 1:2060 FAIRMONT DR
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1001
Mailing Address - Country:US
Mailing Address - Phone:510-346-1454
Mailing Address - Fax:510-614-9516
Practice Address - Street 1:2060 FAIRMONT DR
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1001
Practice Address - Country:US
Practice Address - Phone:510-346-1454
Practice Address - Fax:510-614-9516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHPE376593336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2043541OtherPK
CAPHB356020Medicaid
0532374OtherOTHER ID NUMBER-COMMERCIAL NUMBER