Provider Demographics
NPI:1467737643
Name:DRATE PHARMACY
Entity Type:Organization
Organization Name:DRATE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:OKWUEGBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-589-5989
Mailing Address - Street 1:3219 ADELINE ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-2467
Mailing Address - Country:US
Mailing Address - Phone:510-589-5989
Mailing Address - Fax:510-969-4705
Practice Address - Street 1:3219 ADELINE ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-2467
Practice Address - Country:US
Practice Address - Phone:510-589-5989
Practice Address - Fax:510-969-4705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA533293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA53329OtherCALIFORNIA STATE BOARD OF PHARMACY