Provider Demographics
NPI:1740276286
Name:ELEPHANT PHARMACY OPERATING CORP
Entity type:Organization
Organization Name:ELEPHANT PHARMACY OPERATING CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CATER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:510-549-9201
Mailing Address - Street 1:1607 SHATTUCK AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-1611
Mailing Address - Country:US
Mailing Address - Phone:510-549-9201
Mailing Address - Fax:510-549-9204
Practice Address - Street 1:1607 SHATTUCK AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-1611
Practice Address - Country:US
Practice Address - Phone:510-549-9201
Practice Address - Fax:510-549-9204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH50642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA460850Medicaid