Provider Demographics
NPI:1326219940
Name:OJN INC DBA GOLDEN GATE PHARMACY
Entity Type:Organization
Organization Name:OJN INC DBA GOLDEN GATE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:YOW
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-661-0790
Mailing Address - Street 1:1836 NORIEGA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-4324
Mailing Address - Country:US
Mailing Address - Phone:415-661-0790
Mailing Address - Fax:415-661-0639
Practice Address - Street 1:1836 NORIEGA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-4324
Practice Address - Country:US
Practice Address - Phone:415-661-0790
Practice Address - Fax:415-661-0639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY55295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9037025Medicaid
CA4132420001Medicare NSC