Provider Demographics
NPI:1144571464
Name:KERAMATI, SHIVA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHIVA
Middle Name:
Last Name:KERAMATI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 CRESCENT CT
Mailing Address - Street 2:
Mailing Address - City:BRISBANE
Mailing Address - State:CA
Mailing Address - Zip Code:94005-1225
Mailing Address - Country:US
Mailing Address - Phone:925-890-7088
Mailing Address - Fax:
Practice Address - Street 1:2020 MARKET ST
Practice Address - Street 2:SAFEWAY PHARMACY
Practice Address - City:SAN FRANCISCI
Practice Address - State:CA
Practice Address - Zip Code:94114
Practice Address - Country:US
Practice Address - Phone:415-861-7660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47037183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist