NPIMap

Organization Active NPI

Alameda Health System

Doing business as John George Psychiatric Pavillion Pharmacy

  • Institutional Pharmacy
  • San Leandro, CA
National Provider Identifier
1114083482
Registry record updated Sep 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Institutional PharmacyTaxonomy code 3336I0012X
License
HPE37659 Issued in CA
Legal business name
ALAMEDA HEALTH SYSTEM
Doing business as
John George Psychiatric Pavillion Pharmacy
Practice address
2060 Fairmont Dr
San Leandro, CA 94578-1001
Phone
(510) 346-1454
Fax
(510) 614-9516
NPI assigned
Dec 29, 2006
Last updated
Sep 13, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Martha Yasavolian
Title
Dir of Phcy
Phone
(510) 437-5055

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Institutional Pharmacy 3336I0012X HPE37659 CA Primary

Addresses

Primary practice location

2060 Fairmont Dr
San Leandro, CA 94578-1001

Mailing address

2060 Fairmont Dr
San Leandro, CA 94578-1001
Phone (510) 346-1454

Other identifiers 2

IdentifierTypeStateIssuer
PHB356020MedicaidCA
2043541OtherPK

Other names 1

  • JOHN GEORGE PSYCHIATRIC PAVILLION PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ambulatory Care Service39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

Organizations that report the same tax identification number in the National Provider Directory.

View all 38

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473724800000",
    "number": "1114083482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2060 FAIRMONT DR",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945781001",
            "telephone_number": "510-346-1454",
            "fax_number": "510-614-9516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2060 FAIRMONT DR",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945781001",
            "telephone_number": "510-346-1454",
            "fax_number": "510-614-9516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALAMEDA HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2016-09-13",
        "status": "A",
        "authorized_official_last_name": "YASAVOLIAN",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_title_or_position": "DIR OF PHCY",
        "authorized_official_telephone_number": "510-437-5055"
    },
    "taxonomies": [
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "CA",
            "license": "HPE37659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHB356020",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2043541",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JOHN GEORGE PSYCHIATRIC PAVILLION PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Leandro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.