Provider Demographics
NPI:1396839221
Name:DAVAR, DOLLY (RPH)
Entity Type:Individual
Prefix:
First Name:DOLLY
Middle Name:
Last Name:DAVAR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 FRUITVALE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2418
Mailing Address - Country:US
Mailing Address - Phone:510-535-4000
Mailing Address - Fax:510-535-4128
Practice Address - Street 1:3451 E 12TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601
Practice Address - Country:US
Practice Address - Phone:510-535-3375
Practice Address - Fax:510-535-4169
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH48974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29799ZOtherFFS MEDICARE B
CAZZZ79046ZOtherFFS MEDICARE B
CA551975OtherFFS MEDICARE A
CA051822OtherFQHC MEDICARE A
CAFHC11991FMedicaid
CAFHC71021FMedicaid