Provider Demographics
NPI:1194145649
Name:ABE, CALBERT (PHARMD)
Entity type:Individual
Prefix:
First Name:CALBERT
Middle Name:
Last Name:ABE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:CAL
Other - Middle Name:
Other - Last Name:ABE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:437 OLD MAMMOTH RD
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH LAKES
Mailing Address - State:CA
Mailing Address - Zip Code:93546
Mailing Address - Country:US
Mailing Address - Phone:760-934-4337
Mailing Address - Fax:
Practice Address - Street 1:437 OLD MAMMOTH RD
Practice Address - Street 2:
Practice Address - City:MAMMOTH LAKES
Practice Address - State:CA
Practice Address - Zip Code:93546-2013
Practice Address - Country:US
Practice Address - Phone:760-934-4337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist