Provider Demographics
NPI:1801857958
Name:HEALTHCARE ENTERPRISE LLC
Entity type:Organization
Organization Name:HEALTHCARE ENTERPRISE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLUNOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-867-4177
Mailing Address - Street 1:925 B ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-5109
Mailing Address - Country:US
Mailing Address - Phone:510-538-9711
Mailing Address - Fax:510-538-3204
Practice Address - Street 1:925 B ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-5109
Practice Address - Country:US
Practice Address - Phone:510-538-9711
Practice Address - Fax:510-538-3204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X, 3336S0011X, 3336C0003X
CAPHY50187333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0533782OtherNCPDP PROVIDER IDENTIFICATION NUMBER