Provider Demographics
NPI:1114385143
Name:INTEGRATED MEDICAL ASSOCIATED PHARMACY INC
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL ASSOCIATED PHARMACY INC
Other - Org Name:INTEGRATED MEDICAL ASSOCIATES PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OGBUEHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-382-1671
Mailing Address - Street 1:10500 MACARTHUR BLVD # 103
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-5248
Mailing Address - Country:US
Mailing Address - Phone:510-382-1671
Mailing Address - Fax:510-382-1688
Practice Address - Street 1:10500 MACARTHUR BLVD # 103
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-5248
Practice Address - Country:US
Practice Address - Phone:510-382-1671
Practice Address - Fax:510-382-1688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA537053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158249OtherPK