Provider Demographics
NPI:1821123456
Name:OAK GROVE PHARMACY
Entity Type:Organization
Organization Name:OAK GROVE PHARMACY
Other - Org Name:OAK GROVE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NASER
Authorized Official - Middle Name:
Authorized Official - Last Name:KALIL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:925-681-1823
Mailing Address - Street 1:785 OAK GROVE RD
Mailing Address - Street 2:G2
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-3615
Mailing Address - Country:US
Mailing Address - Phone:925-681-1823
Mailing Address - Fax:925-681-1827
Practice Address - Street 1:785 OAK GROVE RD STE G2
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-3605
Practice Address - Country:US
Practice Address - Phone:925-681-1823
Practice Address - Fax:925-681-1827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHA43276333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA43276OtherPHARMACY LIC #
CA0575831OtherNCPDP
CA0575831OtherNCPDP