Provider Demographics
NPI:1699441923
Name:EBERT, KARLA ROBERTA (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:ROBERTA
Last Name:EBERT
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 DIABLO AVE
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-7311
Mailing Address - Country:US
Mailing Address - Phone:415-898-1905
Mailing Address - Fax:
Practice Address - Street 1:577 JORGENSEN ST
Practice Address - Street 2:
Practice Address - City:COTATI
Practice Address - State:CA
Practice Address - Zip Code:94931-7717
Practice Address - Country:US
Practice Address - Phone:415-722-7204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA145646183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician