Provider Demographics
NPI:1225114283
Name:MA, ALFIE JOSE (PHAMD)
Entity Type:Individual
Prefix:
First Name:ALFIE
Middle Name:JOSE
Last Name:MA
Suffix:
Gender:F
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 SOUTH FRONT ST.
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547
Mailing Address - Country:US
Mailing Address - Phone:510-724-8821
Mailing Address - Fax:
Practice Address - Street 1:280 WEST MACARTHUR BLVD.
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94644
Practice Address - Country:US
Practice Address - Phone:510-752-6468
Practice Address - Fax:510-752-8110
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist