Provider Demographics
NPI:1962770214
Name:TAKEBA, KALLEN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:KALLEN
Middle Name:
Last Name:TAKEBA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 40TH ST
Mailing Address - Street 2:APT 2207
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-3600
Mailing Address - Country:US
Mailing Address - Phone:808-342-2332
Mailing Address - Fax:
Practice Address - Street 1:4501 SAND CREEK RD
Practice Address - Street 2:INPATIENT PHARMACY
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8687
Practice Address - Country:US
Practice Address - Phone:925-813-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist