Provider Demographics
NPI:1982638573
Name:ROYAL MEDICAL INC
Entity Type:Organization
Organization Name:ROYAL MEDICAL INC
Other - Org Name:UNITED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, CLINICAL AFFAIRS
Authorized Official - Prefix:DR
Authorized Official - First Name:DR-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:2006-07-10
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHA4153903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY415390Medicaid