Provider Demographics
NPI:1437339736
Name:UNITED PHARMACY
Entity Type:Organization
Organization Name:UNITED PHARMACY
Other - Org Name:UNITED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PIC
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GUMBS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:510-843-3201
Mailing Address - Street 1:2929 TELEGRAPH AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2017
Mailing Address - Country:US
Mailing Address - Phone:510-843-3201
Mailing Address - Fax:510-843-0308
Practice Address - Street 1:2929 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2017
Practice Address - Country:US
Practice Address - Phone:510-843-3201
Practice Address - Fax:510-843-0308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
CAPHY484133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2112975OtherPK
CAPHY48413Medicaid