Provider Demographics
NPI:1437822871
Name:GOLDEN GATE VETERINARY COMPOUNDING PHARMACY LLC
Entity Type:Organization
Organization Name:GOLDEN GATE VETERINARY COMPOUNDING PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-601-8365
Mailing Address - Street 1:8 DIGITAL DR STE 104
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-5759
Mailing Address - Country:US
Mailing Address - Phone:415-455-5590
Mailing Address - Fax:415-455-9039
Practice Address - Street 1:8 DIGITAL DR STE 104
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-5759
Practice Address - Country:US
Practice Address - Phone:415-455-5590
Practice Address - Fax:415-455-9039
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GGVCP HOLDCO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy